Reframing Child Protection in Emergency Medicine

Area of Science:

• Pediatric Emergency Medicine
• Health Equity
• Child Welfare Systems

Background:

• Child maltreatment is a significant cause of child morbidity and mortality in the US.
• The US child welfare system exhibits systemic racism and inequity, disproportionately affecting Black and Native American children.
• Bias in clinical evaluations and decision-making within emergency departments (EDs) contributes to these disparities.

Purpose of the Study:

• To advocate for an equity lens in child protection within the ED setting.
• To explore how emergency physicians can balance child protection with mitigating harms from an inequitable system.
• To provide actionable recommendations for emergency clinicians on bias mitigation and mandated reporting.

Main Methods:

• This editorial synthesizes existing research on racial disparities in child protective services (CPS) and ED evaluations.
• It analyzes the impact of bias on clinical decision-making for suspected child abuse.
• It proposes an equity-focused framework for emergency physicians.

Main Results:

• Black and Native American children are more likely to be evaluated, reported, removed from homes, and less likely to be reunited with families compared to White children.
• Minority children in EDs are more likely to undergo diagnostic testing and be referred to CPS.
• Bias infiltrates initial clinical evaluations and management of suspected child abuse.

Conclusions:

• Emergency physicians play a critical role in addressing inequities at the "front door" of the child welfare system.
• Implementing an equity lens is crucial for protecting children while avoiding the harms of systemic bias.
• Concrete strategies for bias mitigation and responsible mandated reporting are essential for emergency clinicians.