O3249: An Abolitionist Quality Improvement Project: Leveraging Community to Challenge the Harmful Impact of ACS on Children and Families in East Harlem

Purpose/Objectives: The U.S. child welfare system has long monitored, regulated, and punished poor families– especially Black, Indigenous, and immigrant families. Despite no evidence of higher child abuse rates, Black and Latine families make up the overwhelming majority of Administration for Children’s Services (ACS) cases in New York City.

Our Medicine-Pediatrics residency program provides primary care at a FQHC in East Harlem, a community disproportionately affected by ACS involvement. Our patients, community, and colleagues identified a need for improved support for our families involved with ACS.

The Quality Improvement (QI) project aimed to develop clear, transparent protocols for identifying families within our clinic with current or potential ACS involvement, and to ensure all families are offered community-based support and resources as alternatives to ACS reporting. These aims serve toward a goal of an early framework of abolition in disrupting our traditional ACS reporting practices.

Design/Methods: We implemented a model for improvement to be carried out from July 2024 to July 2025. After gathering input from staff, medical providers, community partners and patients we created initial process maps and cause-effect diagrams. We collected data on current ACS referrals by chart review of cases identified as having ACS involvement via an automated report pulling any chart with an ACS ‘release of records’ form.

Results: We identified 130 children within our cohort with known ACS involvement initiated in the 12 months preceding our project, approximately 3% of our pediatric population at the FQHC. Analysis of these records and interviews with staff revealed several key gaps in ACS-related care within our clinic:

1. Lack of a standardized system for identifying and tracking families with open ACS cases
2. Limited documentation of provider-patient discussions about ACS involvement, particularly during well-child visits
3. Institutional uncertainty about the most effective support services for families navigating ACS involvement.

Conclusion/Discussion: We identified critical gaps in how ACS involvement is identified, documented, and addressed within our clinic. In response to these findings we developed a tracking mechanism to identify families involved with open ACS cases and established a multidisciplinary family support team to collaborate with providers and families prior to, during and after any potential ACS referrals using PDSA cycles. The team includes medical providers, behavioral health specialists, care managers and individuals with lived experience of ACS, one of whom is co-authoring this submission.

As both internists and pediatricians, we are uniquely positioned to intervene at both the child and parent levels, providing alternatives to ACS involvement and a more expansive approach to mitigating the long-term consequences of ACS reports. By the project’s completion, we will evaluate the impact of our intervention by analyzing the implementation of new tracking systems, changes in provider documentation, and engagement with newly established family support initiatives.