Characteristics of child welfare investigations reported by healthcare professionals in Ontario: secondary analysis of a regional database

Abstract

ObjectivesThis study examines the characteristics and outcomes of child welfare investigations reported by hospital-based and community-based healthcare professionals.MethodsA sample of 7590 child maltreatment-related investigations from the Ontario Incidence Study of Reported Child Abuse and Neglect-2018, a cross-sectional study, was analysed. Bivariate analyses compared characteristics of hospital and community healthcare-reported investigations. Chi-square automatic interaction detector analyses were used to predict the most influential factors in the decision to provide a family with services following a child welfare investigation from each referral source.ResultsCommunity healthcare-reported investigations were more likely to have a primary concern of physical abuse while hospital-reported investigations were more likely to be focused on assessing risk of future maltreatment. Hospital-reported investigations were more likely to involve noted primary caregiver (eg, mental health issues, alcohol/drug abuse, victim of intimate partner violence (IPV)) and household risk factors. The most significant predictor of service provision following an investigation was having a caregiver who was identified as a victim of IPV in hospital-reported investigations (χ2=30.237, df=1, adj. p<0.001) and having a caregiver for whom few social supports was noted in community healthcare-reported investigations (χ2=18.892, df=1, adj. p<0.001).ConclusionHealthcare professionals likely interact with children who are at high risk for maltreatment. This study’s findings highlight the important role that healthcare professionals play in child maltreatment identification, which may differ across hospital-based and community-based settings and has implications for future collaborations between the healthcare and child welfare systems.

Adverse childhood experiences (ACEs) are increasing in indigenous populations in Canada: Now what?

“…This table is meant to be an estimate of national trends for both Indigenous-specific and general population trends in Canadian samples, as accurate prevalence estimates of ACEs within national populations are challenging to provide. Reporting can be influenced by individual disclosure or reporting bias (Calheiros et al, 2020; Enosh et al, 2021), the presence and structure of health and child welfare agencies, policies, and providers (Cooley & Jackson, 2020; Livingston et al, 2021), type of maltreatment (Livingston et al, 2021), and seasonality (Shields et al, 2021), in addition to the ability to collect and document reports in a consistent manner within a regionally specific database (Fallon et al, 2010; Leeb & Fluke, 2015; Smith et al, 2017). Although this table is not directly comparable to the method used by Finkelhor (2020), it does describe national data related to family violence and mental health difficulties for Indigenous people in Canada.…”

Understanding the roles of the healthcare and child welfare systems in promoting the safety and well-being of children

“…Healthcare providers in Canada are mandated to report suspected child maltreatment and play an important role in the prevention, identification, and management of child maltreatment concerns ( 4–6 ). Data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018) indicate that child welfare investigations referred by healthcare professionals are more likely to be substantiated and involve more intrusive forms of child welfare involvement, compared to investigations referred by other sources ( 5 , 7 ). In general, families who come into contact with the child welfare system are often struggling in multiple domains, including concerns with economic insecurity, precarious living conditions, intimate partner violence, as well as substance use and mental health issues for caregivers ( 7–9 ).…”

“…Data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2018 (OIS-2018) indicate that child welfare investigations referred by healthcare professionals are more likely to be substantiated and involve more intrusive forms of child welfare involvement, compared to investigations referred by other sources ( 5 , 7 ). In general, families who come into contact with the child welfare system are often struggling in multiple domains, including concerns with economic insecurity, precarious living conditions, intimate partner violence, as well as substance use and mental health issues for caregivers ( 7–9 ). Previous studies looking specifically at hospital-based referrals to child welfare have documented these household- and caregiver-related concerns ( 7 , 10 ).…”

“…In general, families who come into contact with the child welfare system are often struggling in multiple domains, including concerns with economic insecurity, precarious living conditions, intimate partner violence, as well as substance use and mental health issues for caregivers ( 7–9 ). Previous studies looking specifically at hospital-based referrals to child welfare have documented these household- and caregiver-related concerns ( 7 , 10 ).…”

Child Welfare Investigations of Exposure to Intimate Partner Violence Referred by Medical Professionals in Ontario: A Uniquely Vulnerable Population?

“…In this study, we examine the profile of investigations of exposure to IPV referred to child welfare from healthcare settings. Our previous study examining the characteristics of child maltreatment-related investigations reported by healthcare professionals in Ontario found that 29% and 22% of investigations reported by hospital-based and community-based healthcare providers, respectively, involved a primary caregiver who was a victim of IPV [ 15 ]. Due to the physical and mental health impacts of IPV, caregivers and their children may require medical care, either in the emergency department or through primary care, depending on the urgency of their needs [ 11 , 16 ].…”