Hospitals as Reporters: Determinants and Consequences of Early-Life Child Protection Contact

• In Event: Mandatory Reporting, Institutional Variation, and Child Wellbeing: Novel Evidence from the Child Welfare System

Abstract

Hospitals serve as a first line of defense in detecting  child abuse and neglect, including parental substance abuse that occurs during the perinatal period. Obstetric units play a critical role in identifying risk during a pivotal stage of child development and family formation, but there is growing concern that excessive reporting may destabilize families and erode trust in the health care system. Using 20 years of high-quality linked administrative birth, CPS and death records from California,  we study the determinants and consequences of hospital maltreatment reporting around birth. We first show that a large share of early-life CPS contact is driven by hospitals at birth. For instance, approximately 22% of children who are ever placed in foster care are reported in the first month of life. Next, we study variation across hospitals in reporting tendencies.  Hospitals vary substantially in their reporting rates, even after adjusting for birth record characteristics. Among California hospital-years with at least 1,000 births, reporting rates range from under 0.5% to over 10% of newborns. We assess hospital reporting quality using three metrics: false positive rates (reports with no substantiation by age 2), false negative rates (children substantiated by age 2 who were not reported), and reporting risk ratios (ratio of predicted substantiation using birth characteristics for reported children relative to non-reported children). We validate these estimates using a movers-style design that uses consecutive births to the same mother across different hospitals. Finally, given hospitals' role in early detection of severe parental substance abuse and other indicators of maltreatment, and given CPS' relatively high tendency to investigate and remove infants, it is plausible that hospital reporting could either meaningfully benefit children or destabilize families who are falsely reported. We estimate welfare effects of hospital reporting on children and families including child mortality and future CPS involvement, parents' fertility and family stability.

Author

• Katherine Rittenhouse, University of Texas at Austin
  Presenting Author