Partners for Our Children, University of Washington School of Social Work, Seattle, WA.
Partners for Our Children, University of Washington School of Social Work, Seattle, WA.
J Pediatr. 2019 May;208:141-147.e2. doi: 10.1016/j.jpeds.2018.12.065. Epub 2019 Feb 13.
To examine whether hospital-level factors contribute to discrepancies in reporting to Child Protective Services (CPS) of infants diagnosed with prenatal substance exposure.
We used a linked dataset of birth, hospital, and CPS records using diagnostic codes (International Classification of Diseases, Ninth Revision) to identify infants diagnosed with prenatal substance exposure. Using multilevel models, we examined hospital-level and individual birth-level factors in relation to a report to CPS among those infants prenatally exposed to substances.
Of the 760 863 infants born in Washington State between 2006 and 2013, 12 308 (1.6%) were diagnosed with prenatal substance exposure. Infants born at hospitals that served larger populations of patients with Medicaid (OR, 1.25; 95% CI, 1.07-1.45) and hospitals with higher occupancy rates (OR, 1.43; 95% CI, 1.15-1.77) were more likely to be reported to CPS. Infants exposed to amphetamines (OR, 2.58; 95% CI, 2.31-2.90) and cocaine (OR, 2.33; 95% CI-1.92, 2.83) were more likely to be reported and infants exposed to cannabis (OR, 0.62; 95% CI-0.55, 0.70) were less likely to be reported to CPS than infants exposed to opioids. Infants with Native American mothers were more likely to be reported to CPS than infants with white mothers (OR, 1.47; 95% CI, 1.27-1.70).
Hospital-level and individual birth-level factors impact the likelihood of infants prenatally exposed to substances being reported to CPS, providing additional knowledge about which infants are reported to CPS. Targeted education and improved policies are necessary to ensure more standardized approaches to CPS reporting of prenatal substance exposure.
探讨医院层面的因素是否会导致报告给儿童保护服务（CPS）的有产前物质暴露的婴儿数量存在差异。
我们使用了一个基于诊断代码（国际疾病分类，第九版）的出生、医院和 CPS 记录的链接数据集，以识别被诊断为产前物质暴露的婴儿。使用多水平模型，我们检查了医院层面和个体出生层面的因素与这些产前暴露于物质的婴儿向 CPS 报告的关系。
在 2006 年至 2013 年间，华盛顿州出生的 760863 名婴儿中，有 12308 名（1.6%）被诊断为产前物质暴露。在服务更多 Medicaid 患者的人群的医院（OR，1.25；95%CI，1.07-1.45）和床位占用率较高的医院（OR，1.43；95%CI，1.15-1.77）出生的婴儿更有可能被报告给 CPS。暴露于安非他命（OR，2.58；95%CI，2.31-2.90）和可卡因（OR，2.33；95%CI-1.92，2.83）的婴儿更有可能被报告，而暴露于大麻（OR，0.62；95%CI-0.55，0.70）的婴儿则不太可能被报告给 CPS，而暴露于阿片类药物的婴儿则不太可能被报告给 CPS。有美洲原住民母亲的婴儿比有白人母亲的婴儿更有可能被报告给 CPS（OR，1.47；95%CI，1.27-1.70）。
医院层面和个体出生层面的因素影响了向 CPS 报告有产前物质暴露的婴儿的可能性，提供了有关向 CPS 报告哪些婴儿的更多知识。需要有针对性的教育和改进政策，以确保向 CPS 报告产前物质暴露的方法更加标准化。
