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September 16, 2024

Should I Call Child Protection?—Guidelines for Clinicians

Author Affiliations
  • 1University of Rochester and University of Rochester Medical Center, Rochester, New York
  • 2Columbia Law School, New York, New York
  • 3Yale School of Medicine, New Haven, Connecticut
JAMA Pediatr. 2024;178(11):1095-1096. doi:10.1001/jamapediatrics.2024.3624

Child protection investigations are a commonplace occurrence for US children and their families. At current levels of risk, a third of all children and more than half of Black children can expect to experience such an investigation before turning 18 years old.1 While the risk of child protective services (CPS) investigations varies widely across states, significantly greater risk for Black children is a constant.2 In addition, large and long-standing disparities in reports to CPS by socioeconomic class, race, and disability status raise significant concerns about equity and justice. Black children are more likely to be investigated and removed from their homes, and, once removed, spend longer time in substitute care; they are less likely to be reunited with their families and experience termination of parental rights at rates higher than White families.3 Parents with disabilities and parents of children with disabilities are also disproportionately represented among families investigated by CPS. As other studies have identified, physicians and medical professionals contribute to these disparities in reporting.

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3 Comments for this article
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Thank you!
lorenn walker, JD, MPH | University of Hawai‘i at Mānoa
After working for about 15 years with CPS cases that went to court--both in prosecution and defense, later creating alternative community based public health interventions for families that focus on restorative and strength based solutions, and doing lots of researach for the last 25 years, I totally agree with the authors. The CPS government system creates more problems for families--instead of helping people it harms them. Please too if you're interested further in mandated reporting problems see Dorothy Roberts's Torn Apart: How the Child Welfare System Destroys Black Families--and How Abolition Can Build a Safer World. Thank you again!
CONFLICT OF INTEREST: None Reported
Child Safety
Maureen Horsley, MS/BC PED NURSE PRACT | Priority Health NW, Spencer Iowa
As a BC PNP since 1976, I follow state law, and report when "suspect" harm or neglect. Always, I speak about my concerns w/ care providers - stress my desire for help. Dr.Gerald Soloman, Developmental Pediatrician, U of Iowa Dept of Pediatrics - stressed "BE SUSPECIOUS TO THE POINT OF PARANOIA"

IT IS EASIER for us to NOT REPORT!
THE PURPOSE IS TO OBTAIN HELP for the family and protect THE CHILD. -IF THE CPS IS NOT HELPING - THEN WE - caring health PROVIDERS - MUST WORK TO CHANGE THEIR FOCUS! AND form
teams to meet needs.
Please do not use the above opinions as an excuse not to report!
Having testified in court several times - with the hope to help the family - and protect the innocent child/ adolescent -I do believe we can PROTECT and help families. To not report - when harm - is counter productive to LAW and my purpose. In my area, we have NO pediatricians in 13 counties! Please do not abandon children in need. YES, respect culture, but the child must not experience continual abuse, sexual/physical because we believe a report "does no good".
CONFLICT OF INTEREST: None Reported
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We do need some help?
Amarlal Dave |
There were 4.3 million referrals to protective services and 558,900 children were identified as victims of maltreatment. The problem is real and there. The facts that these referrals are biased by race, clor, economics are real. The fact that it causes disruption and destruction of the families of reported due to placement of these reported cases while being investigated and after.
We need "Fmaily supportive services" where the approach to investigate is non-threatening and supportive manner. Currently DCFS means calling cops!

The matter of expertise in terms of knowing abuse & neglect is not as easy
as authors addressed and training programs many of them have no resources/ skills/ expertise in educating residents in this field. We need something akin to BLS/ NRP/ like ongoing education in this respect. The nearest abuse specialist is 90 miles away and it unrealistic to send the people/ families who are already compromised with no car no money !

The hospital nursery where I worked in rural Midwestern Illinois has failed to heed the request to do universal urine drug screening over the last 43 years of my practice, the criteria are biased by color, economic status, social status. The reporting is biased by the drug use as well as other criteria mentioned above. The cannabis use that constitute single most detected get never reported but everything else get reported including controlled substances like amphetamines and methylphenidate. Cocaine always leads to child placement in protective services.

Yes,the system is not a rife with disparities hurting minorities and poors the most and we need an equitable system.
CONFLICT OF INTEREST: None Reported
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