Hospitals in recession-hit areas see uptick in serious cases of child physical abuse

In the largest study to examine the impact of the recession on child abuse, researchers at The Children's Hospital of Philadelphia's (CHOP) PolicyLab detected a significant increase in children admitted to the nation's largest children's hospitals due to serious physical abuse over the last decade. The study, published today in the journal Pediatrics, found a strong relationship between the rate of child physical abuse and local mortgage foreclosures, which have been a hallmark of the recent recession. The CHOP findings, based on data from 38 children's hospitals, contradict national child welfare data, which show a decline in child physical abuse over the same period.

"We were concerned that health care providers and child welfare workers anecdotally reported seeing more severe child physical abuse cases, yet national child protective services data indicated a downward trend," said lead author Joanne Wood, MD, MSHP, an attending physician at CHOP and researcher at PolicyLab. "It's well known that economic stress has been linked to an increase in child physical abuse, so we wanted to get to the bottom of the contrasting reports by formally studying hospital data on a larger scale."

According to the study, overall physical abuse increased by 0.79 percent, and traumatic brain injury increased by 3 percent per year between 2000 and 2009, while overall injury rates fell by 0.8 percent per year over the same time period. The researchers found that each 1 percent increase in 90-day mortgage delinquencies over a one-year period was associated with a 3 percent increase in hospital admissions due to child physical abuse and a 5 percent increase in admissions due to traumatic brain injury suspected to be child abuse.

Dr. Wood says the study highlights opportunities for child welfare agencies and hospitals to collaborate and share data for a more complete picture of child physical abuse rates in communities across the country, in order to develop targeted prevention and intervention.

"Two major themes emerge from this study," said Dr. Wood. "First, we see a clear opportunity to use hospital data along with child welfare data to ensure a more complete picture of child abuse rates both locally and nationally. Second, the study identifies another economic hardship – mortgage foreclosures – that is associated with severe physical abuse. As the foreclosure crisis is projected to continue in the near future, these results highlight the need to better understand the stress that housing insecurity places on families and communities so that we can better support them during difficult times."

PolicyLab's health services researchers, who contributed to the study, note that the public agencies working with vulnerable children and families are better equipped to assist them when the risk factors linked with increased child physical abuse rates are understood. "For example, early prevention efforts could start with a pediatrician or housing counselor providing resources and social services referrals for families," explained Dr. Wood, who is also the research director of Safe Place: Center for Child Protection and Health at CHOP.

According to statistics from the U.S. Department of Health and Human Services, child physical abuse has lasting societal as well as individual consequences, which result in an increased reliance on public assistance and social services– from Medicaid and foster care, to more indirect costs associated with higher rates of criminal activity, mental illness, substance abuse, and domestic violence.

"A study like this cannot tell us what stressors may be impacting an individual family, but can illustrate the toll that the recent recession may be having on families in general, in this country," said David Rubin, MD, MSCE, senior author of the study as well as Director of PolicyLab and an attending pediatrician at CHOP. "It is a reminder to me that when I see families in my practice who have lost their insurance or who have changed homes, to probe a little further about the challenges they are facing. As communities, we all need to reach out a little more to identify which families may be in crisis and help guide them to appropriate resources for support."

The full study, entitled " Local macroeconomic trends and hospital admissions for child abuse, 2000 to 2009", is available online on July 16, in the current issue of Pediatrics. For more information about the study and on PolicyLab's body of child welfare work, visit www.research.chop.edu/PolicyLab.

PolicyLab develops evidence-based solutions for the most challenging health-related issues affecting children. PolicyLab engages in research that is both responsive to community needs and relevant to policy priorities, partnering with practitioners, policymakers, and families throughout the research process. Through its work, PolicyLab identifies the programs, practices, and policies that support the best outcomes for children and their families, disseminating its findings beyond research and academic communities as part of its commitment to transform evidence to action. www.research.chop.edu/PolicyLab

About The Children's Hospital of Philadelphia: The Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country, ranking third in National Institutes of Health funding. In addition, its unique family-centered care and public service programs have brought the 516-bed hospital recognition as a leading advocate for children and adolescents. www.chop.edu.