Understanding the Intersection of Pediatric Palliative Care and Child Abuse Pediatrics (GP716)

Understanding the Intersection of Pediatric Palliative Care and Child Abuse Pediatrics (GP716)

Cleveland R; Keefer P

Journal of Pain and Symptom Management

2020

pediatric palliative care; child protection; Child abuse and neglect; child abuse pediatrics

Objectives: * Describe a framework for understanding circumstances in which Pediatric Palliative Care providers may encounter child abuse or neglect. * Explain the need for future investigations into the overlap of PPC and CPT/CPS. Importance: The intersection of Pediatric Palliative Care (PPC) and child maltreatment is clinically understood to occur. To this point there has not been any published research on the scope of the problem nor any description of the patients who fall into this overlap. Objective(s): To describe medical and demographic characteristics of the population of children seen by both PPC and either an inpatient Child Protective Team (CPT) or state Child Protective Services (CPS). Additional objective was to create a categorization system for said patients. Method(s): Retrospective chart review of 12 years of PPC records. 1803 unique patient charts identified. These were searched for possible child maltreatment, yielding 1405 charts. These were individually reviewed to verify PPC and CPS/CPT involvement, 1216 charts excluded. Demographic and medical data were extracted from the remaining 189 charts. A categorization system based on short narratives of their medical course and reason for CPS/CPT involvement was created. These categories were: 1. An abusive event leading to involvement of PPC and CPS/CPT, 2. A chronic/complex condition for which PPC was involved and the over/under-treatment thereof lead to involvement of CPS/CPT, 3. PPC involvement for a medical process and CPS/CPT involvement for a non-medically-related reason. Descriptive analysis of patients in total and by category was performed. Result(s): 189 of 1803 PPC patients had involvement of CPS/CPT. Of the 189 patients, 26 are in category one, 59 are in category two, and 69 are in category three. Those in category one were statistically more likely to have CPT involvement and concurrent PPC & CPT/CPS involvement. Those in category two were statistically more likely to have concerns for medical neglect. Conclusion(s): PPC children are more frequently involved with CPT/CPS than the general population. There are similarities and differences in their involvement based on their medical history. Impact: This is the first study describing this patient population. The categorization system here developed increases our understanding of this patient population and will aid in future research. Copyright © 2020

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