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Original research
Trends in investigations of abuse or neglect referred by hospital personnel in Ontario
  1. Barbara Fallon1,
  2. Joanne Filippelli1,
  3. Nicolette Joh-Carnella1,
  4. Steven P Miller2,3,
  5. Avram Denburg4
  1. 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
  2. 2 Division of Neurology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  3. 3 Neurosciences and Mental Health, SickKids Research Institute, Toronto, Ontario, Canada
  4. 4 Division of Haematology/ Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Barbara Fallon; barbara.fallon{at}


Background There is a dearth of literature surrounding mandated reporters to child welfare services in the Canadian context. This paper examines 20 years of reporting patterns from hospitals, which represent 5% of all referrals to child welfare services in Ontario.

Methods The Ontario Incidence Study of Reported Child Abuse and Neglect (OIS) is a representative study that has taken place every 5 years since 1993. The OIS is a multistage cluster sample design, intended to produce an estimate of reported child abuse and neglect in the year the study takes place.

Results There have been significant changes in referral patterns over time. Hospital referrals in 2013 are more likely to involve a concern of neglect, risk of maltreatment or exposure to intimate partner violence. In 1993, children were more likely to be referred from a hospital for a concern of physical abuse. Between 1993 and 1998, there was a significant drop in the number of sexual abuse investigations referred from a hospital. Hospitals have low rates of substantiation across all of the OIS cycles.

Conclusion This is the first study to examine hospital-based referral patterns in Canada. The relatively low percentage of hospital referrals across the cycles of the OIS is consistent with the extant literature. The findings warrant further discussion and research. This study is foundational for future research that can assist in identifying and developing responses across sectors that meet the complex needs of vulnerable families and that ultimately promote children’s safety and well-being.

  • child abuse
  • social work

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  • Contributors BF conceptualised the paper. BF, JF and NJ-C synthesised the literature, conducted data analyses and interpretation, and wrote the manuscript. All authors contributed to data interpretation and had input into the manuscript. All authors read and approved the final manuscript.

  • Funding Funding for the Ontario Incidence Study was provided by the Ontario Ministry of Children and Youth Services, Government of Ontario, and support for this secondary analysis was provided through a Social Sciences and Humanities Research Council Connections Grant (no: 611-2015-0137).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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