234 - Child Protective Service Interactions in Children with Cardiac Conditions

Publication Number: 2225.234

Owen S. Henry, University of California, San Diego School of Medicine, San Diego, CA, United States; Rebecca Rebbe, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Brianna Rosenberg, University of California, San Diego School of Medicine, San Diego, CA, United States; Henri Justino, University of California, San Diego School of Medicine, San Diego, CA, United States; Natalie Laub, University of California, San Diego School of Medicine, San Diego, CA, United States

Background: Medically complex children are at higher risk of child protective services (CPS) reports than their healthy peers. However, little is known about the pediatric cardiology population regarding maltreatment reporting and outcomes.

Objective: The aims of this study were to 1) examine rates of CPS reports among a large pediatric cardiology cohort compared to matched healthy peers 2) explore differences in CPS outcomes once reported and 3) identify possible areas of bias in reporting.

Design/Methods: Case-control study using retrospective linked encounters at a tertiary care children’s hospital network (2016-2021), statewide birth and CPS records. Cases were children with a cardiac diagnosis and birth records. Controls without cardiac diagnoses were matched 3:1 based on sociodemographic birth variables. Regression models predicting CPS reports and placements were performed within the cardiac group; marginal effects between the cases and controls were estimated using g-computation.

Results: 13,750 pediatric cardiology patients were included. 54% were male, 42% Hispanic, 36% White, 16% Asian, 4% Black, and 0.4% Native I/A. 41% had public insurance. The most common diagnoses were Electrophysiological (51%), Valvular (24%), and Great Artery disease (21%). A higher percentage of cardiology patients (28.1%) were reported to CPS versus matched controls (21.4%). Marginal relative risks of cardiac diagnosis were significantly higher (p < 0.001) for CPS reports, allegation substantiations, and out-of-home placements. The most common substantiated allegation was general neglect. Cardiology patients with public insurance (RR: 1.91, 95% CI: 1.80-2.02) and those with Black (RR: 1.38, 95% CI: 1.26-1.51) and Native American/Alaska Native (RR: 1.93, 95% CI: 1.51-2.47) mothers were more likely to have CPS reports than those with private insurance and Hispanic mothers. Out-of-home placement was more likely if cardiology patients had Native American/Alaska Native (RR: 8.49, 95% CI: 4.57-15.76) or Black (RR: 2.74, 95% CI: 2.03-3.68) mothers (compared to Hispanic mothers) or those with public insurance (RR: 4.30, 95% CI: 3.32-5.57).

Conclusion(s): CPS reports are higher among pediatric cardiology patients than in the general population. The likelihood of CPS interactions were higher for children with public insurance and Black or Native American/Alaska Native mothers. This study is the first of its kind to characterize CPS reports in a large sample of clinically and socioeconomically diverse pediatric cardiology patients. These findings highlight the vulnerability, disparities, and potential supports needed for these families.