Children With Complex Chronic Conditions in the Child Protective Services

Area of Science:

• Pediatrics
• Public Health
• Social Work

Background:

• Complex chronic conditions (CCCs) significantly impact child welfare.
• Limited data exists on the prevalence and outcomes for children with CCCs within the Child Protective Services (CPS) system.

Purpose of the Study:

• To determine the prevalence of CCCs among children reported to CPS.
• To investigate the associations between CCC designation and CPS outcomes, including maltreatment type, report substantiation, and foster care placement.

Main Methods:

• Retrospective, cross-sectional study utilizing CPS and Medicaid data from Kentucky and Florida (2017-2020).
• CCCs identified using diagnosis codes in Medicaid claims.
• Logistic regression models assessed the adjusted odds ratio (aOR) of having a CCC.

Main Results:

• 8.7% of 610,886 children reported to CPS had a CCC, increasing from 6.2% to 10.7% between 2017 and 2020.
• Children in foster care had 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 represent a distinct, prevalent population within the CPS system, particularly those in foster care.
• Multisectoral support systems are crucial for these children and their families during and before CPS involvement.