Using Medicaid Data to Identify Child Abuse
..... and other musings during the last week of 2023.
Medicaid
In my Google adventures this past week, I came across an interesting 2020 report from the federal HHS Office of Inspector General on using Medicaid data to identify potential child abuse and neglect. The OIG reviewed a year’s worth of Medicaid claims data, honing in on those standardized diagnosis “codes” that reflect abuse and neglect such as sexual abuse, physical abuse, and unspecified maltreatment. Of the almost 30,000 cases in which were found codes related to abuse and neglect, OIG found that 3,928 —over 10% — were involved with incidents that were not reported to child protective services. “We also determined that most incidents of potential child abuse or neglect identified in our sample occurred in familiar settings by alleged perpetrators known to the victims,” the report concluded.
I’m not sure how I missed the OIG report, as I’ve been interested for some time in the use of medical diagnosis codes to pinpoint both prior and current cases of child abuse. Michigan, for example, uses hospital data to flag cases in which a child is born to a family with a significant prior CPS history. There’s plenty of research demonstrating the utility of using these codes to review the effectiveness of medical professionals in detecting and reporting child abuse and neglect. The OIG report recommended that Medicaid authorities encourage states to use the data to identify child abuse. The agency responded that “claims review may not be timely enough to address acute problems because claims and encounter data can be lagged and transformed as they move through the submission process.” An unfortunate response, to say the least.
One wonders if the reluctance of the Centers for Medicare and Medicaid Services to consider this initiative is based as much in the current political atmosphere as anything else. Mandated reporting has come under fire as harmful to poor and minority families, and the use of data to flag children at risk of abuse and neglect has been challenged as discriminatory. Yet we as a society willingly share our personal data with the world every time we log into social media or shop online.
Childhood trauma, mental illness, and inflammatory disorders
The Washington Post reports on the interesting connection that’s been found between inflammatory autoimmune disorders and schizophrenia or schizoaffective disorder. Other research has found a relationship between traumatic stress and inflammation and has suggested a common basis for both immune disorders and traumatic stress disorder. And a meta-analysis of studies has discovered a link between childhood trauma and adult inflammatory disorders related to immune system dysregulation. Many child welfare systems now provide trauma assessments for children entering foster care. Given the significant link between childhood trauma and adult behavioral health and substance abuse disorders, should we also be screening children who’ve suffered abuse and trauma for inflammatory markers?
In other news:
Great article about the work my friends at Wellroot are doing to assist youth making the transition from foster care to adulthood.
Here’s a really good article out of Connecticut about the no-win situation that families often face when their children have significant mental health and trauma histories.
The issue of youth running from foster care continues to get attention.
The British, concerned about the rise of gender identity issues in schools, have issued guidance discouraging social gender transition and encouraging parental notification of student gender dysphoria.
New Hampshire is considering legislation that would authorize the appointment of counsel for children in dependency cases.
A number of states are opting out of the summer EBT program for schools that, during the pandemic, was designed to ensure children continued to get nutritional support.
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