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Disparities in child protective services involvement in pediatric traumatic brain injury
Rachel C Kim1, Priya Aggarwal2, Zirun Zhao2
1Department of Pediatrics, University of California, San Francisco, San Francisco, CA, 94143, USA.
Insights
Pediatric traumatic brain injury (TBI) shows racial and ethnic disparities in child protective services (CPS) involvement. Hispanic children under 2 with TBI had lower odds of CPS case acceptance than non-Hispanic White children.
Area of Science:
- Pediatric Traumatology
- Child Welfare Studies
- Public Health Disparities
Background:
- Traumatic brain injury (TBI) is a major cause of death and disability in children.
- Abusive head trauma leads to worse outcomes than accidental TBI.
- Minority children are disproportionately represented in the child welfare system.
Purpose of the Study:
- To investigate socioeconomic disparities in child protective services (CPS) involvement for pediatric TBI cases.
- To analyze racial and ethnic differences in CPS involvement following pediatric TBI.
Main Methods:
- Retrospective chart review of 596 pediatric TBI patients (2015-2022) at a level I trauma center.
- Included automatic CPS referral for TBI patients aged 2 years or younger.
- Used ANOVA, chi-squared, and logistic regression to compare racial/ethnic groups and odds of CPS case acceptance.
Main Results:
- Significant differences in non-accidental trauma, CPS involvement, insurance, and marital status were observed across racial and ethnic groups (p < 0.05).
- Hispanic children ≤2 years old had lower odds of CPS involvement (OR: 0.38) compared to non-Hispanic White children, after adjusting for confounders.
- Confounders included injury severity, injury type, and socioeconomic status.
Conclusions:
- Racial and ethnic differences exist in pediatric TBI incidence and CPS involvement.
- These disparities persist even with mandatory CPS referral policies for young TBI patients.
Purpose:
Traumatic brain injury (TBI) is a leading cause of pediatric death and disability. Abusive head trauma confers greater morbidity and mortality compared with accidental TBI. National trends reveal disproportionate involvement of minority children in the child welfare system. The study investigates socioeconomic disparities in child protective services (CPS) involvement in pediatric TBI.
Methods:
Retrospective chart review was conducted for TBI patients (n = 596) admitted to an academic pediatric level I trauma center from 2015 to 2022, where institutional policy dictates automatic CPS referral for TBI patients ≤ 2 years. Analysis of variance, chi-squared, and logistic regressions compared racial and ethnic groups and calculated adjusted odds of CPS case acceptance.
Results:
Rates of non-accidental trauma, CPS involvement, insurance, and marital status differed across racial and ethnic backgrounds (p < 0.05). Of patients ≤ 2 years, Hispanic patients (OR: 0.38, 95%CI [0.16,0.91]) had decreased odds of CPS involvement compared to non-Hispanic White patients when adjusting for confounders including injury severity, injury type, and socioeconomic status.
Conclusions:
We highlight racial and ethnic differences in incidence of pediatric TBI and CPS involvement, even in the setting of an automatic CPS referral policy for pediatric TBI patients ≤ 2 years.
