Children With Complex Chronic Conditions in the Child Protective Services.

Abstract

Little is known about the prevalence and outcomes for children with complex chronic conditions (CCCs) in the Child Protective Services (CPS) system. We aimed to determine the prevalence and associations of CCC designation across CPS outcomes and years among a group of children reported in CPS. This was a retrospective, cross-sectional study using CPS and Medicaid data among children enrolled in Medicaid in Kentucky and Florida who were reported to CPS January 1, 2017, to December 31, 2020. The primary outcome was a CCC, distinguished with diagnosis codes in Medicaid claims. We derived logistic regression models to assess the aOR of a child having a CCC by type of maltreatment, report substantiation, and foster care placement, after adjusting for covariates. Among 610 886 children reported to CPS, 8.7% had a CCC. The percentage of children with a CCC increased from 6.2% to 10.7% from 2017 to 2020. A higher percentage of children in foster care vs those who were not had a CCC (18.1% vs 8.3%). Children reported for medical neglect were more likely to have a CCC (aOR, 4.53 [95% CI, 4.32-4.76]) compared with those reported for basic needs neglect. Report substantiation (aOR, 1.21 [95% CI, 1.18-1.24]) and foster care placement (aOR, 1.43 [95% CI, 1.37-1.49]) were both associated with CCC diagnoses. Children with CCCs represent a distinct and prevalent group of children reported to CPS and placed into foster care. Multisectoral systems of support are needed for these children and their families prior to and throughout CPS involvement.