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Identifying newborn discharge to child protective services: Comparing discharge codes from birth hospitalization
Kathleen S Kenny1, Elizabeth Wall-Wieler1, Kayla Frank2
1Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada.
Insights
Hospital discharge codes significantly underestimate newborns entering child protective services (CPS) care. Accuracy was similar across all infants, but the negative predictive value was lower for First Nations newborns.
Area of Science:
- Public Health
- Health Equity
- Child Welfare Research
Background:
- Child protective services (CPS) involvement with newborns disproportionately affects Indigenous and Black families in North America.
- The population health equity implications of newborn removal by CPS are not well understood.
- Accurate data on newborns discharged to CPS is crucial for understanding these inequities.
Purpose of the Study:
- To assess the validity of birth hospitalization discharge codes used to categorize newborns discharged to child protective services (CPS).
- To inform future research on population health inequities related to newborn removal by CPS.
Main Methods:
- Compared hospital discharge codes for newborns discharged to CPS with custody status from CPS case reports.
- Utilized data from 309,260 births in Manitoba, Canada.
- Analyzed data for the overall population and separately for First Nations newborns.
Main Results:
- Hospital discharge codes identified 2678 (0.87%) newborns as discharged to CPS, while CPS case reports confirmed 4562 (1.48%) newborns in CPS custody.
- Discharge codes demonstrated low sensitivity (47.8%) but high specificity (99.8%), with a positive predictive value (PPV) of 81.4% and negative predictive value (NPV) of 99.2%.
- Sensitivity, PPV, and specificity were consistent across all newborns; however, NPV was lower for First Nations newborns.
Conclusions:
- Canadian hospital discharge records significantly underestimate the number of newborns discharged to child protective services (CPS).
- The misclassification rate did not differ based on First Nations status.
- Further research is needed to address the underestimation and improve data accuracy for vulnerable populations.
Purpose:
Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS.
Methods:
Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation).
Results:
Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns.
Conclusions:
Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status.
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