Medical neglect in Canada: a cross-sectional study exploring drivers of substantiation using a national dataset

This study explores child welfare investigations for medical neglect in Canada, focusing on household, family and child characteristics and drivers of substantiated victimisation.

Data from the Canadian Incidence Study of Reported Child Abuse and Neglect 2019 (CIS-2019), the most recent source of Canadian data on child maltreatment-related investigations, were used. A multistaged sampling design was used in the CIS-2019 to select a representative sample of child welfare agencies, and data were collected from investigating child welfare workers at selected agencies over a 3-month sampling period. Complex survey design weights were used to derive an annual estimate of maltreatment-related investigations conducted in the country (299 171 investigations involving children aged 0-15 years). The current study specifically examined the characteristics of the estimated 2934 investigations for medical neglect in the CIS-2019 (1% of all investigations). Bivariate analyses compared medical neglect investigations with investigations involving other forms of neglect, and a binary logistic regression identified characteristics associated with substantiation of medical neglect.

Compared with other neglect investigations, medical neglect investigations were more likely to involve children less than 1 year old, caregivers under 21 years old and over 30 years old, households whose primary source of income was full-time work, primary caregivers with mental health concerns, and children with at least one functioning concern. Medical neglect investigations in which the primary caregiver had noted alcohol abuse (OR=4.693, p<0.001), drug/solvent abuse (OR=2.485, p<0.001) or mental health concerns (OR=2.231, p<0.001) were more likely to be substantiated.

Medical neglect is a child welfare concern with potentially dire consequences. We demonstrate that substantiated cases of medical neglect in Canada arise within the context of complex caregiver and child factors. Early collaboration, preventative efforts and supportive relationships between families and their healthcare teams could enhance adherence to medical recommendations and mitigate harm to the child.