Predictors of Making a Referral to Child Protective Services Prior to Expert Consultation

Authors

Danielle Zamalin
Irene Hamlin
Justine Shults
M Katherine Henry
Kristine A Campbell
James D Anderst
Angela N Bachim
Rachel P Berger
Lori D Frasier
Nancy S Harper
Megan M Letson
John D Melville
Daniel M Lindberg
Joanne N Wood

Publication Date

1-1-2024

Journal

Academic Pediatrics

DOI

10.1016/j.acap.2023.05.002

PMID

37178908

PMCID

PMC10638459

PubMedCentral® Posted Date

1-1-2025

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Child, Humans, Child Protective Services, Child Abuse, Child Welfare, Pediatricians, Referral and Consultation, child physical abuse, disparities, child protective services, referral

Abstract

OBJECTIVE: Suspicion for child abuse is influenced by implicit biases. Evaluation by a Child Abuse Pediatrician (CAP) may reduce avoidable child protective services (CPS) referrals. Our objective was to investigate the association of patient demographic, social and clinical characteristics with CPS referral before consultation by a CAP (preconsultation referral).

METHODS: Children <5 years-old undergoing in-person CAP consultation for suspected physical abuse from February 2021 through April 2022 were identified in CAPNET, a multicenter child abuse research network. Marginal standardization implemented with logistic regression analysis examined hospital-level variation and identified demographic, social, and clinical factors associated with pre-consultation referral adjusting for CAP’s final assessment of abuse likelihood.

RESULTS: Among the 61% (1005/1657) of cases with preconsultation referral, the CAP consultant had low concern for abuse in 38% (384/1005). Preconsultation referrals ranged from 25% to 78% of cases across 10 hospitals (P < .001). In multivariable analyses, preconsultation referral was associated with public insurance, caregiver history of CPS involvement, history of intimate partner violence, higher CAP level of concern for abuse, hospital transfer, and near-fatality (all P < .05). The difference in preconsultation referral prevalence for children with public versus private insurance was significant for children with low CAP concern for abuse (52% vs 38%) but not those with higher concern for abuse (73% vs 73%), (P = .023 for interaction of insurance and abuse likelihood category). There were no differences in preconsultation referral based on race or ethnicity.

CONCLUSIONS: Biases based on socioeconomic status and social factors may impact decisions to refer to CPS before CAP consultation.