Clinical Framework for Dismantling Antiblack Racism in the Clinic Room

Abstract

Children who identify as Black or multiracial report significantly higher exposure to adverse childhood experiences, which places them at greater risk for poor mental and physical health outcomes. These disparities and increasing awareness of racism as an adverse childhood experience has resulted in the American Academy of Pediatrics, American Psychological Association, and other groups declaring racism a public health crisis. To provide high-quality care, providers who engage with patients and families impacted by systemic racism must be aware of its role in health disparities. This requires clinicians to have the knowledge and skills to discuss racism with colleagues, patients, and families. To promote clinicians’ competence to engage in these discussions, this article 1) sensitizes providers to historical and contextual factors that inform experiences with anti-Black racism and health disparities and 2) offers strategies to address anti-Black racism in clinical care.Embracing the process of brave, informed conversations about race represents a pathway for building trust between providers and patients, a key component of various health outcomes. Additionally, these foundational skills of reflection, cultural humility, and bias recognition will be needed to engage in allyship and advocacy both within and beyond the exam room.

Illustrating the application of brief integrated behavioral health prevention visits.

“…Building off the Healthy Steps approach (Minkovitz et al, 2003), our model was designed to serve the unique needs of our patients who predominantly identify as Black or Latinx, live below the federal poverty threshold, include many non-English speaking and immigrant/refugee families, have limited resources, and often present with complex psychosocial stressors and trauma exposure. Our universal, standardized approach includes brief contact during all WCVs for children ages birth to five, values community connectedness, and emphasizes a trauma-informed, two-generation lens (e.g., recognizing the impact of caregiver well-being on the infant/young child; Herbst et al, 2023). Prior publications provide greater detail about our IBH-P program components and data elements (e.g., Ammerman et al, 2022; Herbst et al, 2020).…”

Applications of motivational interviewing in adolescent solid organ transplant

“…Relatedly, consistent with an MI approach, purposeful self-reflection and cultural humility are important clinical skills in order to effectively partner with patients and families from diverse backgrounds. 25…”

“…In doing so, it is necessary to be aware of personal biases that may affect clinical practice, including implicit or explicit attitudes and beliefs that may be projected onto our patients. Relatedly, consistent with an MI approach, purposeful self‐reflection and cultural humility are important clinical skills in order to effectively partner with patients and families from diverse backgrounds 25 …”