Pediatric Consultations to Child Protective Services: The Role of Expert Opinions
The purpose of this study was to provide a description of the types of child abuse
consultations done by experts at Yale-New Haven Childrens Hospital (YNHCH) to
Child Protective Services (CPS) in Connecticut, and compare the opinions of the
likelihood of child maltreatment of the initial treating physician, CPS, and the child abuse
Eligible cases were referred by CPS for expert child abuse consultations at
YNHCH between March, 1998 and June, 2005. Abstracted information included
demographics, information about the type of injury, and the assessments of the case by
the initial treating physician, CPS, and the child abuse expert.
Of 187 cases, 49% were males; 30% were African American, 28% white, 23%
Hispanic, 1% Asian, and 17% were of unknown ethnicity. The types of cases, defined by
the most serious overall injury to the child varied: 46% involved fractures; 22% bruises,
scars, or abrasions; 13% burns; 4% brain hemorrhages; 2% death; 1% retinal
hemorrhage; and 7% other injuries; in 5% of cases no physical injury to the child was
found by any of the assessors.
In 57% (N=68) of the 119 cases that had opinions by all three assessors, the expert
agreed with the opinion of the original physician on the case; of these 68 cases, 44 were
abuse, 6 were uncertain, and 18 were accidental. In 65% (N=77) of cases the expert
agreed with CPS on the case; of these cases, 50 were abuse, 2 were uncertain and 25 were
accidental. The expert was more likely to determine the case to be accidental (49% of
cases) compared to CPS (25% of cases), and the original physician (18% of cases).
When CPS believed the case to be abuse (69 cases), the expert most often agreed it was
abuse (72%), but in 22% of cases disagreed and determined the case to be accidental.
Overall, the expert thought 48% of the cases were abuse. When no explanation
was given by the caretaker to account for the childs injury (N= 18), the expert was very
likely to find the case one of abuse (72%); in contrast, when an explanation was provided
by the caretaker for a fall (N=45) or an accident by the child (N=16), the expert was less
likely to find the case one of abuse (35% and 31%, respectively).
Factors that increased the probability of the expert determining the case to be one
of abuse included: the child had a medical or psychological problem, the child was on
record with CPS for a previous concern of maltreatment, CPS removed the child from the
home or provided parental services/education, and the child had 3 or more injuries.
Although there was agreement in a substantial proportion of cases, in a significant
number of cases the child abuse expert had opinions that differed from CPS and the
treating physician. Therefore, second opinions by child abuse experts have important
value in selected child abuse cases both to confirm previous assessments by the treating
physician and CPS, and to change the opinion of the case.
School Location:USA - Connecticut
Source Type:Master's Thesis
Keywords:child protective services abuse diagnosis yale new haven children s hospital connecticut pediatrics
Date of Publication:05/06/2009