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Child Protection System Interactions for Children With Positive Urine Screens for Illicit Drugs
Rebecca Rebbe1, Denise Malicki2,3,4, Nadia Siddiqi5
1University of North Carolina at Chapel Hill School of Social Work, Chapel Hill.
Insights
Child protection system (CPS) involvement for children testing positive for illicit drugs is documented. Less than half of children were reported to CPS, with uncommon out-of-home placements, raising questions about services received.
Area of Science:
- Pediatric Health
- Child Welfare
- Toxicology
Background:
- Increasing rates of illicit drug ingestion among young children.
- Lack of data on child protection system (CPS) responses to positive drug tests in children.
- Need to understand the characteristics of children and CPS involvement following positive drug screens.
Purpose of the Study:
- To document child protection system involvement for children testing positive for illicit substances.
- To characterize children experiencing positive urine drug screens in a pediatric hospital setting.
Main Methods:
- Retrospective cross-sectional study linking medical discharge and CPS administrative data.
- Inclusion of emergency department and inpatient encounters for children aged 12 years or younger with positive urine drug tests (2016-2021).
- Analysis of drug types and CPS responses including reports, substantiations, case openings, and out-of-home placements.
Main Results:
- 511 encounters involved children with positive drug tests; 47.7% were reported to child protection, and 11.9% were placed out-of-home within 30 days.
- Quarterly counts of positive drug test encounters doubled post-COVID-19 pandemic onset, with cannabis-positive encounters tripling.
- Infants (<1 year) were significantly more likely to have associated CPS reports and case openings compared to older children.
Conclusions:
- Less than half of children with positive urine drug screens were reported to CPS, and out-of-home placements were infrequent.
- The doubling of positive drug test encounters post-pandemic highlights an increasing need for intervention.
- Further research is needed to determine the services provided to children and families experiencing positive drug tests.
Importance:
Young children are ingesting illicit drugs at increased rates, but it is unknown what the associated child protection system (CPS) responses are when a child tests positive.
Objective:
To document the child protection system involvement and the characteristics of children who test positive for illicit substances.
Design, Setting, And Participants:
This retrospective cross-sectional study linked medical discharge and child protection system administrative data. The setting was Rady Children's Hospital San Diego, a free-standing pediatric hospital in California. Participants included all emergency department and inpatient medical encounters involving children aged 12 years or younger with a positive urine drug test between 2016 and 2021. Statistical analysis was performed from February 2023 to January 2024.
Exposure:
Drug type, including amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, fentanyl, opiates, and phencyclidine.
Main Measures And Outcomes:
CPS responses associated with the medical encounter including reports, substantiations, case openings, and out-of-home placements.
Results:
A total of 511 emergency department and inpatient medical encounters involving children had a positive drug test (262 [51.3%] were female; 309 [60.5%] were age 6 years or younger; fewer than 10 [<3.0%] were American Indian or Alaska Native; 252 [49.3%] were Hispanic [any race], 20 [3.9%] were non-Hispanic Asian, 56 [11.0%] were non-Hispanic Black, 143 [28.0%] were non-Hispanic White, 36 [7.0%] had other or unknown race and ethnicity; 233 [43.6%] had a CPS report prior to the medical encounter). Following the positive screen, 244 (47.7%) were reported to child protection, and 61 (11.9%) were placed out-of-home within 30 days. Mean (SD) quarterly counts of encounters with positive drug tests doubled after the COVID-19 pandemic onset (32.9 [9.8]) compared with prior to the pandemic onset (16.5 [4.7]); for encounters positive for cannabis, mean (SD) quarterly counts were 3 times as high after the pandemic onset than prior (16.6 [4.7] vs 5.7 [2.9]). Encounters for children under age 1 were significantly more likely to have associated child protection reports (relative risk [RR], 2.91 [95% CI, 2.21-3.83]) and child protection case openings (RR, 1.71 [95% CI, 1.07-2.72]) than encounters involving older children.
Conclusions And Relevance:
In this cross-sectional study of emergency department and inpatient medical encounters, less than half of children with positive urine drug screens were reported to CPS; out-of-home placements were uncommon. With increased encounters for positive drug tests, it is unclear what services these children and families are receiving.
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