Children With Complex Chronic Conditions in the Child Protective Services

Area of Science:

• Pediatrics
• Public Health
• Child Welfare

Background:

• Complex chronic conditions (CCCs) significantly impact child development and healthcare needs.
• The intersection of CCCs and the Child Protective Services (CPS) system is understudied.
• Understanding this population is crucial for effective child welfare and healthcare interventions.

Purpose of the Study:

• To determine the prevalence of CCCs among children reported to CPS.
• To examine the associations between CCC designation and CPS outcomes, including maltreatment type, report substantiation, and foster care placement.
• To analyze trends in CCC prevalence within the CPS system over a four-year period.

Main Methods:

• Retrospective, cross-sectional study utilizing linked CPS and Medicaid data.
• Inclusion of children reported to CPS in Kentucky and Florida from January 1, 2017, to December 31, 2020.
• Logistic regression models used to assess adjusted odds ratios (aOR) for CCCs based on CPS involvement characteristics.

Main Results:

• 8.7% of 610,886 children reported to CPS had a CCC, with prevalence increasing from 6.2% to 10.7% between 2017 and 2020.
• Children in foster care showed a higher CCC prevalence (18.1%) compared to those not in foster care (8.3%).
• Medical neglect reports (aOR, 4.53) were strongly associated with CCCs, as were report substantiation (aOR, 1.21) and foster care placement (aOR, 1.43).

Conclusions:

• Children with CCCs constitute a significant and identifiable group within the CPS system.
• These children are disproportionately represented among those placed in foster care.
• Integrated, multisectoral support systems are essential for children with CCCs and their families during and before CPS involvement.