Identifying newborn discharge to child protective services: Comparing discharge codes from birth hospitalization records and child protection case files

Kathleen S Kenny; Elizabeth Wall-Wieler; Kayla Frank; Lindey Courchene; Mary Burton; Cheryle Dreaver; Micheal Champagne; Nathan C Nickel; Marni Brownell; Cathy Rocke; Marlyn Bennett; Marcelo L Urquia; Marcia Anderson

doi:10.1016/j.annepidem.2024.01.001

Identifying newborn discharge to child protective services: Comparing discharge codes from birth hospitalization records and child protection case files

Ann Epidemiol. 2024 Mar:91:44-50. doi: 10.1016/j.annepidem.2024.01.001. Epub 2024 Jan 4.

Authors

Affiliations

¹ Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada. Electronic address: Kathleen.Kenny@umanitoba.ca.
² Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada.
³ First Nations Family Advocate Office, 200-286 Smith Street, Winnipeg, R3C 1K4, Manitoba, Canada.
⁴ Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Fearless R2W, PO Box 44095 Redwood Postal Outlet, Winnipeg, R2W 5M3, Manitoba, Canada.
⁵ Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada.
⁶ Faculty of Social Work, University of Regina, Education Building 456, Regina S4S 0A2, Saskatchewan, Canada.
⁷ Faculty of Social Work, University of Calgary, 2500 University Dr NW MacKimmie Tower 301, Calgary T2N 1N4, Alberta, Canada.
⁸ Manitoba Centre for Health Policy, University of Manitoba, Room 408-727 McDermot Avenue, Winnipeg R3E 3P5, Manitoba, Canada; Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, 155 College Street, Room 500, Toronto M5T 3M7, Ontario, Canada.
⁹ Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Room S113 - 750 Bannatyne Avenue, Winnipeg R3E 0W3, Manitoba, Canada; Ongomiizwin Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, P122 Pathology Building, 770 Bannatyne Ave, Winnipeg R3W 0W3, Manitoba, Canada.

PMID: 38184029
DOI: 10.1016/j.annepidem.2024.01.001

Abstract

Purpose: Newborn removal by North America's child protective services (CPS) disproportionately impacts Indigenous and Black families, yet its implications for population health inequities are not well understood. To guide this as a domain for future research, we measured validity of birth hospitalization discharge codes categorizing newborns discharged to CPS.

Methods: Using data from 309,260 births in Manitoba, Canada, we compared data on newborns discharged to CPS from hospital discharge codes with the presumed gold standard of custody status from CPS case reports in overall population and separately by First Nations status (categorization used in Canada for Indigenous peoples who are members of a First Nation).

Results: Of 309,260 newborns, 4562 (1.48%) were in CPS custody at hospital discharge according to CPS case reports and 2678 (0.87%) were coded by hospitals as discharged to CPS. Sensitivity of discharge codes was low (47.8%), however codes were highly specific (99.8%) with a positive predictive value (PPV) of 81.4%, and a negative predictive value (NPV) of 99.2%. Sensitivity, PPV and specificity were equal for all newborns but NPV was lower for First Nations newborns.

Conclusions: Canadian hospital discharge records underestimate newborn discharge to CPS, with no difference in misclassication based on First Nations status.

Keywords: Child protective services; First Nations; Indigenous; Infant removal; Misclassification; Newborn.

MeSH terms

Birth Certificates
Canada
Child Protective Services*
Hospitals
Humans
Infant, Newborn
Patient Discharge*