Identifying risk of child welfare involvement in Orange County births with the Bridges Program

To promote the early identification and support of children at risk for developmental issues and other adversities, seven of Orange County, California's largest birthing hospitals have adopted a “hospital screening” process comprised of an initial clinical data scan, followed by the completion of a more robust bedside assessment. This approach to hospital screening and referral, termed the “Bridges Program,” is used to connect parents of high-risk newborns to home visiting services aimed at providing support and resources. Orange County also has four birthing hospitals that do not participate in the Bridges Program, which allowed for the comparison of births occurring between 2011 and 2012 at Bridges hospitals (n = 53,302) to births at non-Bridges hospitals (n = 25,146) on various child protection outcomes by age five, accounting for program engagement and demographic differences. Bridges assessments successfully identified births at higher risk for child protection service involvement, and high-risk Bridges births not forwarded for agency outreach were significantly more likely to be reported and substantiated for maltreatment compared to low risk Bridges births (RR = 1.18, CI = [1.08, 1.30]; RR = 1.30, CI = [1.10, 1.54]). These results highlight a subset of births that would benefit from alternative strategies for engaging with home visiting services.