A Population-Based Study of Child Maltreatment-Related Hospitalizations and Child Protection Responses

Abstract

Despite the breadth of the identified impacts and costs of child maltreatment, a primary challenge in our understanding of child maltreatment is that we still do not have solid numbers of children who experience it. Further, despite child protection systems (CPS) being reliant on mandated reporters to bring concerns of child maltreatment to their attention, there is little information about how systems respond to concerns of child maltreatment. Informed by the public health approach and ecological systems theory, this dissertation utilizes a novel linked administrative dataset of birth, hospital discharge, and CPS records to provide new knowledge about hospitalizations related to child maltreatment. It does so in three ways: identifying the incidence and prevalence of child maltreatment-related hospitalizations, the risk and protective factors of these hospitalizations, and the systems responses to these hospitalizations, as measured by CPS reports and removals by CPS. Results indicate that most common form of child maltreatment-related hospitalizations was neglect and, more specifically, supervisory neglect. Identified risk factors included child’s low birth weight, mothers who were teenagers at the time of birth, non-first born children, maternal residence in zip codes with high concentrated disadvantage, and a prior CPS report. System responses were dependent on the subtype of maltreatment and type of diagnostic code used. Specifically, physical abuse and codes specifically related to maltreatment had higher rates of CPS reports and removals compared to the other maltreatment subtypes and diagnostic codes not specifically related to maltreatment. These results provide new knowledge regarding child maltreatment. The results can be used to target prevention programming, which are identifiable at birth, increasing their utility. The new knowledge identified through this study has important implications for our understanding of child maltreatment, how we can prevent it, and how current systems are responding to it.