(1752) Characterizing Differences Among Referred and Non-Referred Children to Child Protective Services

Introduction: Medical providers must refer patients to Child Protective Services (CPS) if there is reasonable suspicion of abuse and neglect. While reporting should be done in an equitable manner, explicit and implicit biases may be present. In this two-part study to measure association of CPS referrals to patient characteristics, we hypothesize that there exist significant differences in demographic variables between referred and non-referred patients.

Methods: In this two-part study, phase I is a retrospective cohort study with all patients referred to CPS from the emergency department (ED) and inpatient (INP) units at Golisano Children’s Hospital from 1/1/15–1/1/23. We report demographic characteristics and the most common diagnoses associated with referrals. Phase II is a case-control study including all ED and INP patients with the most common referral diagnoses from Phase I. We measure associations between referral status and demographic features, child opportunity index (COI) quintile, payor, means of arrival, illness severity, and disposition using Chi-square and Wilcoxon signed rank tests.

Results: Phase I had 2,559 CPS referrals, with 2,147 (84%) from the ED and 412 (16%) from INP. COI quintile was significantly associated with referral status, with patients living in neighborhoods with “very low” COI referred at a higher rate (p < 0.001). Phase II had 208,184 (77.1%) ED patient encounters and 61,729 (22.9%) inpatient encounters. Limiting to top diagnoses found in Phase I identified 17,927 ED patients, of whom 5.6% were referred. Similar diagnoses filtering identified 2,539 inpatients, of whom 5.1 % were referred. All comparisons made between patients in the ED group were found to have a significant association between the covariate of interest and referral status (p < 0.001), and patient disposition was found to be associated with referral (p < 0.001) in the INP group.

Conclusions: In this multi-phase study, we identified the most common diagnoses and features of patients referred to CPS from the ED and INP units. Demographic features were significantly associated with referral status among those referred from the ED. We will further explore these associations using multivariable analysis of referred and non-referred patients matched by age.