Locating Youth Exposed to Parental Justice Involvement in the Electronic Health Record: Development of a Natural Language Processing Model

Background: Parental justice involvement (eg, prison, jail, parole, or probation) is an unfortunately common and disruptive household adversity for many US youths, disproportionately affecting families of color and rural families. Data on this adversity has not been captured routinely in pediatric health care settings, and if it is, it is not discrete nor able to be readily analyzed for purposes of research. Objective: In this study, we outline our process training a state-of-the-art natural language processing model using unstructured clinician notes of one large pediatric health system to identify patients who have experienced a justice-involved parent. Methods: Using the electronic health record database of a large Midwestern pediatric hospital-based institution from 2011-2019, we located clinician notes (of any type and written by any type of provider) that were likely to contain such evidence of family justice involvement via a justice-keyword search (eg, prison and jail). To train and validate the model, we used a labeled data set of 7500 clinician notes identifying whether the patient was ever exposed to parental justice involvement. We calculated the precision and recall of the model and compared those rates to the keyword search. Results: The development of the machine learning model increased the precision (positive predictive value) of locating children affected by parental justice involvement in the electronic health record from 61% (a simple keyword search) to 92%. Conclusions: The use of machine learning may be a feasible approach to addressing the gaps in our understanding of the health and health services of underrepresented youth who encounter childhood adversities not routinely captured-particularly for children of justice-involved parents.