P2.047: Predicting Child Welfare Involvement in Children with Medical Complexity: Social and Patient Factors

Background: Biases within the healthcare system impact providers' habits in reporting suspected abuse and neglect. At the Bower Lyman Center for Medically Complex Children (BLCMCC), a high number of reports to the Department of Children and Families (DCF) prompted an investigation. This study examines how biases influence reporting dynamics, including who reports, where referrals occur, and their outcomes. By analyzing these factors, we aim to uncover underlying biases that affect the reporting process and highlight the need to address systemic biases impacting vulnerable families.

Methods: Charts of patients aged 0-21 at the BLCMCC were reviewed. Data collected included maternal age at birth, social determinants of health (utilization of resources for housing, food security and transportation), race, ethnicity, and technology dependence. For those reported to DCF, we documented where the report was placed, reasons for reporting (medical neglect, abuse, social concerns), and report outcomes. Statistical analysis included chi-squared, t-tests, and logistic regression for odds ratios, with a significance level of p< 0.05.

Results: Of 600 charts reviewed, 196 were referred to DCF, with a median referral age of 3.8 years. Most referrals (122/196) came from hospitals, while BLCMCC referred only 20. Medical neglect was the primary reason (38%) for referral. 41% were closed without action, and 36% led to foster care or adoption. Approximately 25% of patients had subsequent reports. Logistic regression showed maternal age significantly influenced referrals (p < 0.001), with each year above the median age of 29 decreasing odds by 6% (Exp(B)= 0.940). Younger mothers (22 vs. 29) had 1.5 times higher odds. Housing (p= 0.003; Exp(B)= 2.052) and transportation assistance (p= 0.003; Exp(B)= 1.975) increased referral odds, while enteral tubes (p= 0.004; Exp(B)= 2.067) also correlated with higher odds. Ventilation needs were linked to lower odds (p= 0.021; Exp(B)= 0.392).

Conclusion: Our study highlights critical insights into dynamics of reporting among children with medical complexities. The analysis demonstrates younger maternal age, requiring housing or transportation assistance and dependence on technology all significantly increases the likelihood of referrals DCF. The need for ventilation assistance was associated with lower odds of reporting, possibly due to the increased presence of home nursing in this population vs healthcare workers being uncomfortable with assessing these children for signs of abuse and neglect. The odds of referral were over 6 times as likely from the hospital compared to BLMCC where providers have much greater knowledge of family dynamics. This discrepancy may reflect biases inherent in the healthcare system highlighting the necessity for targeted training for healthcare professionals to enhance reporting confidence and address the systemic biases that may affect vulnerable families. More research is needed to understand how social factors influence referral rates and outcomes for these children and families.