Children in child protective services custody experience higher risk of intramuscular medication and physical restraints in a pediatric emergency department.

Abstract

To assess the association between child protective services (CPS) involvement and the risk and timing of intramuscular (IM) medication or physical restraint use in pediatric patients presenting to the emergency department (ED) with behavioral health concerns. An electronic health record dataset spanning January 2021 to October 2023 was retrospectively analyzed. Individual cumulative incidence plots and Cox regression models were created to model the risk and risk rate of receiving either IM medication or being physically restrained by different levels of CPS involvement. Cox regression models were adjusted for age, legal sex, and race and ethnicity. We analyzed 6257 behavioral health encounters. Children in CPS custody had the highest cumulative incidence of receiving IM medication or being physically restrained compared to children with a new CPS report filed or children without any CPS involvement after 72 hours (IM medication: 17%, 6%, 5% respectively, p < 0.001, physical restraints: 8%, 4%, 3% respectively, p < 0.001). Compared to children without CPS involvement, children in CPS custody had a significantly higher risk rate of receiving IM medications (adjusted hazard ratio (aHR) 1.79, 95% Confidence Interval (CI) 1.01-3.18, p = 0.046), and physical restraints (aHR 2.71, 95% CI 1.35-5.43 p = 0.005). Children in CPS custody had a higher risk of receiving IM medication and being physically restrained during behavioral health encounters in a pediatric ED. Further work should focus on understanding the causal mechanisms and designing interventions that maximize optimal health outcomes for vulnerable children experiencing behavioral health emergencies.