The COVID-19 pandemic and heightened awareness of police brutality after the killings of George Floyd, Breonna Taylor, and many others, have shifted our focus so that systemic racism finally centers in the discussion of children’s mental health. Specifically, racism has been identified as a social determinant of mental health. Although this pivot in the collective consciousness and the canon of child and adolescent psychiatry has recently begun, previous research exploring racism’s direct effect on child mental health, while limited, has been overlooked and underfunded despite this problem persisting for several decades. We will review data on systemic racism and discrimination and its impact on the mental health for youth and their families with an emphasis in systems of care settings, juvenile justice, and child welfare. This presentation will explore 3 theoretical frameworks: 1) Public Health Critical Race Praxis (PHCRP); 2) structural competency; and 3) racism as a root cause, to propose determination of research, policy, and practice priorities to address mental health inequity in Black, Latinx, and Native American (BLNA) youth whose well-being has been historically marginalized in these systems of care settings. This presentation includes a review of data on racial inequity across child mental health serving systems. Findings from research conducted by the presenter and colleagues investigating promising practices applying antiracist praxis will be discussed. Systemic racism in various sectors (eg, education, legal, health) drives the disproportionate contact that BLNA youth have with systems of care and influences negative health outcomes across their developmental trajectories. In particular, BLNA youth experience greater gaps between treatment need and receipt. These gaps in both service linkage and quality of care received have lifelong intersectional implications on long-term adverse outcomes. Addressing systemic racism requires multimodal interventions that apply antiracist frameworks to create actionable praxis across the domains of research, policy, and practice. PHCRP, structural competency, and racism-as-a-root-cause frameworks can help center the needs and voices of historically marginalized groups and stimulate new approaches to achieve equitable health outcomes.
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