The Dangers of Congregate for Children with Diabetes or Other Life-Threatening Medical Conditions

TL;DR

This paper highlights the risks of placing children with diabetes in congregate care and suggests legal and training improvements to prevent harm.

Contribution

The paper introduces legal and training recommendations to protect children with diabetes in congregate care settings.

Findings

Two children with diabetes died in congregate care due to staff training deficiencies.

Legal safeguards exist but are ineffective without proper staff training.

Alternative pathways and programs are proposed to ensure child safety.

Abstract

Background: Children can be removed from their home if allegations of abuse or neglect are substantiated. The preference is to place them with family members. In the most extreme cases, a child may be placed in a congregate care setting. A child with diabetes should only be placed in such a facility if the staff have been appropriately trained. Otherwise, the consequences can be devastating. In 2022 and 2024, two children were placed into congregate care facilities in Arizona and died of diabetic ketoacidosis due to a lack of appropriate employee training. Study Objective: We aim to inform providers of the legal processes and laws that can result in a child being placed into a congregate care setting. We analyze what went wrong in the care of these two children. We present alternative pathways that might ensure the safety of children before they are placed in such facilities. Methodology: We reviewed public information for cases of morbidity and mortality in children with diabetes in congregate care. We reviewed the California Welfare and Institution legal codes and applicable laws in the Federal Register. We obtained information regarding children with diabetes mellitus who were in the care of child welfare on PubMed. Results and Conclusions: While there are legal safeguards for children with diabetes who are placed in congregate care, these safeguards are ineffective if staff are inappropriately trained. We present programs and recommendations to prevent a child who is placed in a congregate care facility from suffering medical complications or death.