Docs more likely to suspect abuse in poor kids

By Amy Norton - Reuters

(Reuters Health) - When a toddler has a broken bone, pediatricians may be more likely to suspect abuse if the family is lower-income, a new study finds.

Researchers found that pediatricians who read a fictional case report of a toddler with a leg fracture were more likely to suspect abuse if the child was described as coming from a lower-income family.

The hypothetical child's race, on the other hand, did not appear to influence doctors' opinions.

The second finding is somewhat surprising, according to the researchers. Studies looking at real-world cases have found that minority children are more likely to be evaluated for abuse than white children are.

And it's well known that the child welfare system in the U.S. has a disproportionate number of minority kids.

"There's very strong evidence of a racial difference in how patients are handled," said lead researcher Dr. Antoinette L. Laskey, a pediatrician at the Indiana University School of Medicine in Indianapolis.

But, she told Reuters Health, the reasons for that have not been clear -- including whether doctors may act based on unconscious racial stereotypes.

The current results suggest "there's more than race involved," Laskey said.

She was also quick to say, however, that the study doesn't mean pediatricians are consciously "classist" or otherwise biased when evaluating children's injuries.

The study, reported in the Journal of Pediatrics, included 2,100 U.S. pediatricians who responded to a survey that described one of four hypothetical cases.

All cases included an 18-month-old with an "ambiguous" leg fracture -- a type that can be caused by abuse or an accident.

But the cases varied by the child's race (black or white) and the family's economic situation; parents were described as having either professional jobs (accountant and bank manager) or working-class jobs (grocery clerk and factory worker).

Race had little effect on the doctors' responses. The study found that when the child was black, 45 percent of doctors believed there had "possibly" or "almost certainly" been abuse; another 32 percent were "unsure." If the child was white, 46 percent of pediatricians suspected abuse, with 28 percent saying they were unsure.

In contrast, there was evidence that parents' job descriptions swayed doctors' opinions.

When the child's family was lower-income, 48 percent of pediatricians thought there'd been abuse, versus 43 percent when the family was higher-income.

It's hard to know whether doctors' responses to a fictional case would be the same in real life.

And it's not clear, according to Laskey, whether attitudes about socioeconomic status might explain some of the racial differences in child abuse reporting seen in earlier studies.

She also stressed that she does not think pediatricians are consciously basing their diagnoses on parents' job titles. But in general, unconscious stereotypes can influence anyone's thinking.

"People tend to think that child abuse, or domestic violence, doesn't happen in upper-middle-class families, but of course it does," Laskey said.

It's important, she said, for doctors to be aware that unconscious generalizations could get in the way of diagnosing child abuse -- either missing it in kids from affluent families, or over-diagnosing it in children from poorer or minority families.

"My big take-home message for doctors is that we need to rely on the objective data," Laskey said.

It is true that studies have found children in poorer families to be at greater risk of abuse. But the poverty, itself, is not a "causative factor," Laskey said.

"Race and socioeconomic status shouldn't be things used in a diagnosis of abuse," she said.

SOURCE: Journal of Pediatrics, online January 5, 2012.

Source http://www.reuters.com/article/2012/01/20/us-docs-abuse-idUSTRE80J1WK20120120

N.J. Assembly panel approves bill to broaden how DYFS investigators define child abuse

By Susan K. Livio/Statehouse Bureau

TRENTON — After the deaths last year of two girls whose parents were not deemed a threat by the Division of Youth and Family Services, an Assembly panel approved a bill Thursday that would broaden how investigators define child abuse in New Jersey.

The measure (A-4109/S1570), which was unanimously approved by the Assembly Human Services Committee, must be approved by the full Assembly no later than Tuesday morning, when the two-year legislative session draws to a close. The Senate has already approved it.

Under the proposed bill, agency investigators could choose among three findings when determining whether there is a valid abuse complaint instead of the current two, which some say limits the ability to protect children.

The proposed measure would allow investigators to "substantiate" a claim if there was sufficient evidence, consider it "unfounded" if no safety risk was detected, or select a new third option — "not substantiated." That would apply if there was not enough evidence to support a complaint, but investigators suspected the child was still "placed at substantial risk of harm."

The families of both children had been investigated for abuse and neglect, but a number of times DYFS workers considered the concerns "unfounded."

Since 2004, the term "unfounded" has held two meanings — no evidence of abuse, or some evidence but not enough to make a solid case. The state dropped the "unsubstantiated with concerns" category out of concern that investigators were not gathering enough facts to make a valid decision.

"Hopefully this legislation will help investigators capture a sizeable portion of abuse cases that might otherwise fall through the cracks," said Assemblywoman Valerie Vainieri Huttle (D-Bergen), the committee chairwoman who was a sponsor of the bill.

Jesse Moskowitz, a retired assistant director of DYFS, said passage of the measure by the panel "represents an acknowledgement that a well-intended but flawed change six years ago required correction and clarification in order to accurately classify child abuse or neglect findings."

Support for the bill is not unanimous.

"They should be focusing on clarifying policy and improving quality of investigations so that they make good determinations, not feel comfortable with an inconclusive category," Judith Meltzer, a court-appointed monitor who is overseeing an overhaul of the state’s child welfare system, said afterward.

A representative from the Communications Workers of America Local 1038, representing 3,000 DYFS employees, testified in support the bill, but at the same time asked the committee to look into an increasing number of caseloads investigators are handling but the agency is hiding.

The representative, Cataherine Donatos, said the agency was trying to conceal the number of cases out of concern that the judge who ordered the overhaul would find the state out of compliance and order sanctions.

She said that in one DYFS office, 27 workers who investigate child abuse exceeded the court-imposed limit of 12 cases a month, with some juggling 15 to 21 cases.

She added that some cases were transferred to other professionals on paper, but that that staffers were still doing the work and that those who did not find a way to lower casesloads were disciplined.

Donatos said that after the union filed a grievance, the agency transferred six workers and hired a supervisor.

A spokeswoman for DYFS, Leida Arce, said transferring cases to other staff when the workload increased was "a common practice" because everyone is trained in investigations.

Source http://www.nj.com/news/index.ssf/2012/01/assembly_panel_approves_bill_t_2.html