Racism and Child Mental Health 8/27/2020

As the frontline of healthcare, the primary care clinic can play an important role in assuring equal access to care for all our kids and families. The following materials highlight the

In 2019, the American Academy of Pediatrics published a policy statement on the “The Impact of Racism on Child and Adolescent Health” highlighting the pervasive effects of systemic racism Trent et al, 2019). The authors reference the following definition of racism:

“a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call ‘race’) that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.”

They further clarify, “Racism is a social determinant of health that has a profound impact on the health status of children, adolescents, emerging adults, and their families”

While current spotlight in 2020 on the impact of racism on our culture has intensified, we have long seen the impacts of race and racism in the literature. As just one example, in 2013, the Substance Abuse and Mental Health Treatment Administration found that across America, black adolescents diagnosed with major depressive disorder received mental health treatment at a much lower rate (28.6%) than white adolescents (41.6%). Other disparities as to access, diagnostic variability, and treatment availability have been noted and differential long term outcomes have reported.

This drives home the need for providers and health organizations to consider steps to mitigate the harmful effects of racism. Here are some approaches to consider (among many others)

• “Create a culturally safe medical home where the providers acknowledge and are sensitive to the racism that children and families experience by integrating patient and family-centered communication strategies and evidence-based screening tools that incorporate valid measures of perceived and experienced racism into clinical practice”
• Promote programs that increase access to care for underserved communities
• For patients who report experiencing racism, assess for associated mental health conditions, including signs of posttraumatic stress, anxiety, grief, and depressive symptoms, using validated screening tools and a trauma-informed approach to make referrals to mental health services as needed”
• Conduct quality-assurance assessments that include analyses of quality of care and patient satisfaction by race, and respond accordingly
• “Encourage policies to foster interactive learning communities that promote cultural humility and provide simulation opportunities to ensure new pediatricians are competent to deliver culturally appropriate and patient and family-centered care”

Attention to issues of bias at individual, team, organizational, econoic and other levels, can afford opportunities to address the negative impacts of conscious and unconscious bias on health care delivery and outcomes.

Reference: Trent, M., Dooley, D. G., Dougé, J., & On, S. (2019). The Impact of Racism on Child and Adolescent Health, 144(2). Policy Statement American Academy of Pediatrics.

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