174 - Impact of Race and Insurance Status on Consulting Social Work and Reporting to Child Protective Services Following Ingestions in Young Children

Poster Number: 174
Publication Number: 174.1651

Background: Children commonly present to Emergency Departments (EDs) for ingestions. Providers may consult social work (SW) or file reports to Child Protective Services (CPS) for concerns of supervisory neglect, though no clear guidelines exist to inform these decisions. Black, Hispanic and publicly insured children are over-reported to CPS for suspected physical abuse, but it is unknown whether these disparities exist for children presenting after ingestions.

Objective: To examine the association of race, ethnicity, and insurance status and consulting SW or reporting to CPS following ingestions in young children.

Design/Methods: We extracted data on children less than 6 years presenting to one of 6 hospitals in one health system between 2013 and 2022 following an accidental ingestion or poisoning. We excluded children in the foster care system, those with unexplained injuries and those with prior reports to CPS. We performed bivariate analyses to examine associations between demographic and clinical factors and referrals to SW or CPS. Multivariable logistic regression was used to adjust for potential confounders.

Results: We identified 759 eligible children. The median age was 2.0 (IQR 1.0-3.0) years. The majority were male (54.8%), categorized as publicly insured/self-pay (54.7%) and of white race (45.5%); 29.8% were Hispanic. Most ingestions were over the counter medications (48.4%). Substances illegal for a minor (e.g., cannabis, alcohol, methadone) were responsible for 3.2% of ingestions.

SW was consulted in 22.9% (n=174) of patients and more frequently in black vs. white (33.1% vs. 22.9%; p=.002) and publicly vs privately insured children (27.0% vs 18%; p =.003). CPS reports were made for 6.7% (n=51) of patients and more frequently in publicly vs. privately insured children (8.4% vs. 4.7%; p = 0.04). There were no significant associations between CPS reports and race or ethnicity.

In multivariate analyses, SW consults and CPS reports were not significantly associated with race, ethnicity or insurance type. Both outcomes were associated with clinical factors such as a change in mental status and/or hospitalization. SW consults were additionally associated with ED type and CPS reports were associated with ingestion type, with substances considered illegal for a minor being the biggest predictor. (Tables 1 & 2)

Conclusion(s): In this preliminary analysis, we did not identify disparities in consulting SW or reporting to CPS based on demographic factors, but instead found an association with clinical, hospital, or ingestion-related factors. Next steps include confirming these findings in a multicenter study.