Trends in investigations of abuse or neglect referred by hospital personnel in Ontario

Abstract

BackgroundThere is a dearth of literature surrounding mandated reporters to child welfare services in the Canadian context. This paper examines 20 years of reporting patterns from hospitals, which represent 5% of all referrals to child welfare services in Ontario.MethodsThe Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) is a representative study that has taken place every 5 years since 1993. The OIS is a multistage cluster sample design, intended to produce an estimate of reported child abuse and neglect in the year the study takes place.ResultsThere have been significant changes in referral patterns over time. Hospital referrals in 2013 are more likely to involve a concern of neglect, risk of maltreatment or exposure to intimate partner violence. In 1993, children were more likely to be referred from a hospital for a concern of physical abuse. Between 1993 and 1998, there was a significant drop in the number of sexual abuse investigations referred from a hospital. Hospitals have low rates of substantiation across all of the OIS cycles.ConclusionThis is the first study to examine hospital-based referral patterns in Canada. The relatively low percentage of hospital referrals across the cycles of the OIS is consistent with the extant literature. The findings warrant further discussion and research. This study is foundational for future research that can assist in identifying and developing responses across sectors that meet the complex needs of vulnerable families and that ultimately promote children’s safety and well-being.

Sentinel surveillance of child maltreatment cases presenting to Canadian emergency departments

“…As CHIRPP does not usually provide information as to whether the child is receiving services from child welfare, or information regarding what happen after the initial injury event, our findings are likely underestimates. Our findings are however consistent with studies regarding health care professionals under-reporting CM to child welfare services [9] although an Ontario study found that the proportion of referrals to child welfare agencies for CM investigations from hospitals doubled between 1993 and 2013 [37]. An unexpected finding in our study was the number of cases that indicated injury due to CM during a visitation with a parent or step-parent.…”

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

“…Hospital-reported investigations were significantly more likely to have a primary investigation concern of future risk of maltreatment, likely due to the presence of multiple risk factors across different domains (ie, primary caregiver and household factors), in addition to the crisis that led them to seek acute care. 7 26 31 The higher percentage of hospital-reported investigations that involved infants also likely contributed to the larger proportion of risk investigations reported by hospitals. 26 The results of the CHAID analysis show that the decision to provide hospital-reported families with additional supports was largely driven by having a primary caregiver who was identified as a victim of IPV and had noted drug/solvent abuse.…”

“…Within the Canadian context, an analysis of data from the Ontario Incidence Study of Reported Child Abuse and Neglect 2013 (OIS-2013) revealed that investigations reported by hospital-based providers most often involved concerns for children at risk of future maltreatment, followed by concerns of exposure to intimate partner violence (IPV), neglect and physical abuse. 7 Investigations that assess whether a child is at risk of future maltreatment are not focused on alleged maltreatment but rather on assessing if risk factors in the child’s environment may lead to future maltreatment, including concerns about the caregiver. 11 Hospital-based reports are often initiated because caregivers require acute care for medical needs related to domestic violence, substance abuse or a mental health crisis.…”

Child maltreatment online education for healthcare and social service providers: Implications for the COVID-19 context and beyond

“…Results from the most recent Canadian Incidence Study of Child Abuse and Neglect conducted in 2008, indicated that nearly 250,000 cases of suspected child maltreatment are investigated on an annual basis; less than one-quarter of these investigations are initiated following reports from healthcare and social service providers (HSSPs) ( Tonmyr, Li, Williams, Scott, & Jack, 2010 ). The low report rate by HSSPs, especially by hospital personnel (∼5%) ( Fallon, Filippelli, Joh-Carnella, Miller, & Denburg, 2019 ; Tonmyr et al, 2010 ), is concerning given that the proportion of children and adolescents who are experiencing child maltreatment and who come to the attention of child protection authorities is already considered a huge underestimate of the true incidence in the Canadian population ( Public Health Agency of Canada, 2010 ). Furthermore, other evidence indicates that HSSPs experience challenges in recognizing less overt forms of child maltreatment (e.g., emotional abuse, emotional neglect, children’s exposure to IPV), initiating conversations with children and caregivers about potential maltreatment concerns, and ensuring private, safe spaces for children to discuss their concerns and experiences ( Beynon, Gutmanis, Tutty, Wathen, & MacMillan, 2012 ; Kimber, McTavish, Couturier et al, 2019 , 2019b ; McTavish et al, 2017 ; Tufford, Bogo, & Asakura, 2014 ; Tufford, Bogo, Katz, Lee, & Ramjattan, 2019 ).…”