Reddy Julia, Halpern Carolyn T, Schiff Davida M, Jones Hendree, Austin Anna, Faherty Laura, Rebbe Rebecca, Vines Anissa, Putnam-Hornstein Emily
Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
J Pediatr. 2025 Jul;282:114546. doi: 10.1016/j.jpeds.2025.114546. Epub 2025 Mar 19.
To describe child protection system (CPS) reports after delivery and examine associations between individual- and hospital-level predictors and CPS reporting in a cohort of infants with prenatal substance exposure.
This state-level, retrospective cohort study used administrative data to analyze births to Black, White, and US-born Hispanic mothers with documented prenatal substance exposure. We used a random intercept mixed-model with individual- and hospital-level predictors to capture any association between birth hospital and CPS reporting. Interaction terms allowed for different effects dependent on characteristics of the delivering parent and the dominant demographics of the hospital setting.
Among 260 525 births during 2018 in California, 2.6% had documented substance exposure, with observed racial differences in substance use and type. Nearly 4% of births to Black mothers had documented cannabis exposure compared with roughly 1% among White and Hispanic mothers. The delivery hospital explained 24% of variance in CPS reporting. Hierarchical models revealed race and insurance-type differences in the likelihood a CPS report followed a substance exposed birth. Namely, publicly-insured births in hospitals where majority births were covered by private insurance had nearly twice the probability of being reported compared with those with private insurance.
We found variation in CPS reporting of births with diagnosed substance exposure at the hospital level, and interactions between hospital- and individual-level characteristics in their association with the likelihood of CPS reporting. Associations offer insight into potential areas of bias and inconsistency in policy implementation that might be diminished through improved decision-making tools and provider training.
描述分娩后儿童保护系统（CPS）报告情况，并研究产前接触物质的婴儿队列中个体和医院层面预测因素与CPS报告之间的关联。
这项州级回顾性队列研究使用行政数据，分析有记录的产前接触物质的黑人、白人和美国出生的西班牙裔母亲的分娩情况。我们使用具有个体和医院层面预测因素的随机截距混合模型，以捕捉分娩医院与CPS报告之间的任何关联。交互项考虑了根据分娩父母的特征和医院环境的主要人口统计学特征产生的不同影响。
在2018年加利福尼亚州的260525例分娩中，2.6%有记录的物质接触情况，且在物质使用和类型方面存在种族差异。黑人母亲分娩中有近4%有记录的大麻接触情况，而白人和西班牙裔母亲中这一比例约为1%。分娩医院解释了CPS报告中24%的变异。分层模型显示，在物质接触分娩后CPS报告的可能性方面存在种族和保险类型差异。具体而言，在大多数分娩由私人保险覆盖的医院中，公共保险分娩被报告的概率几乎是私人保险分娩的两倍。
我们发现在医院层面，已诊断物质接触分娩的CPS报告存在差异，且医院层面和个体层面特征在与CPS报告可能性的关联中存在相互作用。这些关联为政策实施中潜在的偏差和不一致领域提供了见解，可通过改进决策工具和提供者培训来减少。
