Professor University of Louisville Louisville, Kentucky, United States
Background: Racial disparities within child protective services (CPS) and healthcare systems have been linked to structural racism, bias, and criminalization of poverty. Pediatric health care providers are mandatory reporters of child abuse and neglect yet have the capability to connect children and families to needed medical, mental, and social care resources. Few studies collect voices of Black parents/caregivers and community members serving this population to better understand fear as a barrier to pediatric health care. Objective: To explore (1) how concerns about CPS involvement affects access and acceptance of pediatric medical and social care among urban Black parents/caregivers and (2) how providers can navigate concerns to improve access in a pediatric clinical setting. Design/Methods: Data were collected from three focus groups that consisted of urban Black parents/caregivers (18+) residing in West Louisville (n=22). Additionally, semi-structured interviews were conducted with community stakeholders (e.g., pediatricians, social workers, community advocates, CPS professionals) (n=10). Broad, open-ended questions explored perspectives on race, healthcare, child protective services, and the uptake of social care resources. Data were analyzed as a team using constructivist grounded theory – an inductive, systematic qualitative approach. Themes were identified through several cycles of data analysis and interpretation. Results: The 32 participants shared a variety of experiences and perspectives and many had direct experiences with the CPS system. Of the parents/caregivers who completed the demographics survey, 50% experienced a CPS investigation as a parent/caregiver and 40% experienced it as a child. Four themes were identified, which included (1) both CPS fear and fear related to previous healthcare experiences affect accessing and accepting pediatric care, (2) race and poverty influence CPS referrals and healthcare experiences, (3) improving communication and transparency among CPS, providers, and families are opportunities to decrease fear, and (4) building strong provider-family relationships and creating positive clinical and community experiences are opportunities to build trust.
Conclusion(s): Fear is a barrier to pediatric health care in Black communities which will continue to drive racial disparities if not addressed. Using perspectives from Black parents/caregivers and community stakeholders should shape the way we address needed changes in CPS and healthcare. Demographic Table.jpeg
