Race and Bias in Child Maltreatment Diagnosis and Reporting.

Abstract

* Abbreviation: CPS — : child protective services Pediatricians have implicit and explicit racial biases that impact the health and well-being of children and their families.1,2 Similarly, effects of racism on diagnosis and reporting of suspected child abuse and neglect to child protective services (CPS) can have serious consequences. Although we and others are mandated to report suspected child abuse or neglect in all US states and territories, the threshold for reporting requires only “reasonable suspicion” of abuse or neglect.3 Pediatricians may also report families that they perceive need additional resources. Research on racial bias and physician reporting is limited.4 Disproportionality in reporting is widespread on the basis of race, culture, and ethnicity. Asian American and Hispanic children are underrepresented, but overrepresentation of Black children throughout the child protection system has been most widely described.5 Black children are reported at approximately twice the rate of white children, and the complex relationship of reporting with poverty and race has yet to be fully understood.4–6 Once reported, cases with Black children are more likely to be accepted for investigation, be confirmed, be brought to court, result in removal of the children from their families for longer periods of time, and take longer to be closed, possibly related to surveillance bias.5,7 Multiple points in this process are subject to bias, but the process begins with reporting.8,9 The concept of bias has been recognized and discussed within the medical community for at least half a century. Diagnostic errors due to bias can lead to errors in reporting.10 Although physicians have historically been key players in the development … Address correspondence to Vincent J. Palusci, MD, MS, FAAP, Department of Pediatrics, Grossman School of Medicine, New York University, 462 First Ave, Room GC-65, New York, NY 10016. E-mail: vincent.palusci{at}nyulangone.org