Medical neglect investigations in the Ontario child welfare system: Findings from the Ontario incidence study of reported child abuse and neglect 2013

Objectives: Medical neglect investigations constitute a small proportion of substantiated child welfare investigations in Canada and the United States; however, medical neglect can result in serious short and long-term... [ view full abstract ]

Objectives: Medical neglect investigations constitute a small proportion of substantiated child welfare investigations in Canada and the United States; however, medical neglect can result in serious short and long-term consequences for children. The purpose of this paper is to understand the unique characteristics of medical neglect investigations and determine if these investigations are more likely to document physical harm to the child.
Methods: Quantitative data and case narratives from the Ontario Incidence Study of Reported Child Abuse and Neglect 2013 were used to provide a profile of medical neglect investigations in Ontario. Medical neglect investigations were compared to investigations involving other forms of neglect using chi-square analyses. A logistic regression was conducted to determine whether medical neglect is significantly more likely to result in physical harm compared to other forms of neglect. Analysis of case narratives provided thematic support for the quantitative results.
Results: An estimated 1,774 medical neglect investigations were conducted in Ontario in 2013. Investigations focusing on medical neglect were significantly more likely to involve an infant, a child with physical disabilities, Fetal Alcohol Syndrome or a developmental delay, and caregivers with few social supports or a history of foster care/group home in childhood. Physical harm was more often noted for medical neglect investigations at the bivariate level. Controlling for other child and family factors, medical neglect investigations were over four times more likely to result in physical harm (OR=4.7, p<.001). Case narrative analysis revealed five categories of medical neglect: dental, developmental, primary care, preventative healthcare, mental health and neglect related to a chronic illness.
Conclusions and Implications: Investigations focusing on medical neglect involve families with numerous child, caregiver and household-level needs requiring a coordinated service response. Categories of referral related to medical neglect could be used to guide the provision of services.