{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T09:03:37Z","timestamp":1790845417545,"version":"4.1.0"},"reference-count":68,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Young children are ingesting illicit drugs at increased rates, but it is unknown what the associated child protection system (CPS) responses are when a child tests positive.<\/jats:p><\/jats:sec>Objective<\/jats:title>To document the child protection system involvement and the characteristics of children who test positive for illicit substances.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cross-sectional study linked medical discharge and child protection system administrative data. The setting was Rady Children\u2019s Hospital San Diego, a free-standing pediatric hospital in California. Participants included all emergency department and inpatient medical encounters involving children aged 12 years or younger with a positive urine drug test between 2016 and 2021. Statistical analysis was performed from February 2023 to January 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Drug type, including amphetamines, barbiturates, benzodiazepines, cannabis, cocaine, fentanyl, opiates, and phencyclidine.<\/jats:p><\/jats:sec>Main Measures and Outcomes<\/jats:title>CPS responses associated with the medical encounter including reports, substantiations, case openings, and out-of-home placements.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 511 emergency department and inpatient medical encounters involving children had a positive drug test (262 [51.3%] were female; 309 [60.5%] were age 6 years or younger; fewer than 10 [&amp;lt;3.0%] were American Indian or Alaska Native; 252 [49.3%] were Hispanic [any race], 20 [3.9%] were non-Hispanic Asian, 56 [11.0%] were non-Hispanic Black, 143 [28.0%] were non-Hispanic White, 36 [7.0%] had other or unknown race and ethnicity; 233 [43.6%] had a CPS report prior to the medical encounter). Following the positive screen, 244 (47.7%) were reported to child protection, and 61 (11.9%) were placed out-of-home within 30 days. Mean (SD) quarterly counts of encounters with positive drug tests doubled after the COVID-19 pandemic onset (32.9 [9.8]) compared with prior to the pandemic onset (16.5 [4.7]); for encounters positive for cannabis, mean (SD) quarterly counts were 3 times as high after the pandemic onset than prior (16.6 [4.7] vs 5.7 [2.9]). Encounters for children under age 1 were significantly more likely to have associated child protection reports (relative risk [RR], 2.91 [95% CI, 2.21-3.83]) and child protection case openings (RR, 1.71 [95% CI, 1.07-2.72]) than encounters involving older children.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cross-sectional study of emergency department and inpatient medical encounters, less than half of children with positive urine drug screens were reported to CPS; out-of-home placements were uncommon. With increased encounters for positive drug tests, it is unclear what services these children and families are receiving.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.3133","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T15:01:29Z","timestamp":1711033289000},"page":"e243133","source":"Crossref","is-referenced-by-count":7,"title":["Child Protection System Interactions for Children With Positive Urine Screens for Illicit Drugs"],"prefix":"10.1001","volume":"7","author":[{"given":"Rebecca","family":"Rebbe","sequence":"first","affiliation":[{"name":"University of North Carolina at Chapel Hill School of Social Work, Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Malicki","sequence":"additional","affiliation":[{"name":"University of California, San Diego"},{"name":"Rady Children\u2019s Hospital, San Diego, California"},{"name":"Chadwick Center for Children and Families, San Diego, 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