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Child Protective Services Referral in a Cleft Lip and/or Palate Population: Assessment of Prevalence, Indications,
Alison Kaye1,2, Karina Shah2, Sandra Lybrand3
1Division of Plastic Surgery, Children's Mercy Kansas City, Kansas City, MO, USA.
Insights
Child Protective Services (CPS) referrals for children with cleft lip/palate often stem from medical neglect, impacting long-term care. Early identification of psychosocial risks and increased family support may help prevent these referrals.
Area of Science:
- Pediatric Health
- Craniofacial Anomalies
- Social Work in Healthcare
Background:
- Cleft lip and palate (CLP) populations present unique care challenges.
- Child Protective Services (CPS) referrals can impact patient care trajectories.
- Understanding referral patterns is crucial for comprehensive support.
Purpose of the Study:
- To determine the prevalence of CPS referrals in a CLP population.
- To identify reasons for CPS referrals in this cohort.
- To examine the outcomes of CPS referrals and associated risk factors.
Main Methods:
- Retrospective cohort study at a tertiary children's hospital.
- Reviewed patients under 18 with CPS referrals from 2009-2014.
- Analyzed referral reasons, outcomes, and psychosocial risk factors.
Main Results:
- 1.8% of 1392 CLP patients were referred to CPS, mostly under one year old.
- Referrals were often linked to medical neglect and cleft care issues (64%).
- Psychosocial risks included financial strain, mental illness, and lack of support; 9 families lost custody.
Conclusions:
- CPS referrals in CLP patients indicate complex care needs.
- Medical neglect is a common referral reason, potentially causing care delays and custody loss.
- Proactive identification of at-risk families and enhanced support may mitigate CPS involvement.
Objective:
To determine the prevalence of, reasons for, and outcomes related to Child Protective Services (CPS) referral in an isolated and syndromic cleft lip/palate population.
Design:
Retrospective cohort study.
Setting:
Tertiary Children's Hospital.
Patients:
Any patient <18 years of age attending the multidisciplinary cleft team for care at our institution with a history of referral to CPS by the cleft team during the study period 2009 to 2014.
Main Outcome Measures:
The number of children with CPS referrals, reasons for CPS referrals, outcomes of CPS referrals, associated psychosocial risk factors potentially predictive of CPS referral; demographics and cleft-related surgical history was also reviewed for each patient.
Results:
Of 1392 patients, 25 (1.8%) were identified with a history of referral to CPS. Average age at referral was 11 months; 76.0% of patients were <1 year of age. Most referrals (64.0%) were directly associated with issues related to cleft care. Identified psychosocial risk factors included financial strain, mental illness/cognitive disability, transportation issues, and inadequate social support. Nine families ultimately lost custody of their children temporarily (n = 5) or permanently (n = 4).
Conclusions:
Cleft team family referral to CPS involves long-term patient care challenges requiring maximal medical and social support. Families are most commonly referred for issues related to medical neglect, which can lead to failure to thrive, delays in care, and ultimate removal from the home. Identifying families with known psychosocial risk factors and providing increased support may potentially help avoid referrals to CPS.
