Racism in child welfare: Ethical considerations of harm

Abstract

Racism has resulted in significant disproportionality and disparity in the US child welfare system. Being Black is not an inherent risk factor for child abuse and neglect yet Black children are almost twice as likely to be victims of substantiated abuse and neglect claims compared to other racial groups. Addressing the disproportionality within the child welfare system due to systemic racism falls squarely under the purview of bioethics. In this paper, we briefly review the impact of racism on child welfare. We then discuss some ethical considerations that mandatory healthcare reporters should think through when determining whether to report potential abuse and neglect. Specifically, we discuss the need for a broader consideration of what constitutes harm. We then present a hypothetical composite case to illuminate where and how bias can enter the process of referral to child protective services (CPS). We encourage thoughtful reporting with consideration of social and historical context and alternative explanations for worrisome findings. We recommend using evidence, avoiding assumptions by seeking clarification from families and ensuring internal consistency. When contemplating CPS referral, medical providers should feel empowered to ask questions if there is concern for potential bias. The ultimate goal is to protect children from harm. If there are clear safety concerns-they must be addressed. However, in the many cases where the safety concern is less tangible, we need to expand our considerations of the harms that can befall children, especially children of color.

The Impact of Social Vulnerability on Substance Use Detection Practices in Pregnancy

“…Research has shown Black individuals have been the disproportionate recipients of these adverse social and legal consequences compared with White individuals. 55,56 As is highlighted in this review, socially vulnerable individuals are targeted for uTox testing, regardless of self-reported use or clinical indications for testing. There are limitations to our review.…”

The future of childhood maltreatment research: Diversity and equity-informed perspectives for inclusive methodology and social justice

“…This side also points to the overrepresentation of American Indian/Alaskan Native (AIAN) children in the child welfare system and to a lesser extent, Latinx children, compared to White children (Hanna, 2021;Tajima et al, 2022). They argue that the disproportionalities of minoritized children in the child welfare system exceed the proportions that would be expected based on the representation of children from these groups in the general populations of the United States, as well as Canada and England (Berkman et al, 2022;Cénat et al, 2021;Roberts, 2014).…”

“…Overestimation may be particularly true of cases characterized by neglect, which are among the most difficult and controversial to substantiate and the most likely to confound issues of poverty that disproportionately affect minoritized families (Barnett et al, 1993;Berkman et al, 2022;Havlicek & Courtney, 2016;Roberts, 2014). Neglect is the most frequently substantiated subtype of maltreatment, particularly for minoritized (and specifically, Black) families (Rebbe, 2018;Roberts, 2014), and the most frequently occurring subtype in many prospective studies (e.g., Danese & Widom, 2020;Raby et al, 2017).…”

Associations between nurse characteristics, institutional characteristics and perceived nurse knowledge and self‐efficacy of reporting suspected child abuse and neglect

“…Berkman et al. (2022) urges CAN mandated reporters to consider the historical context of systemic racism and how reporting can cause more harm to the child; hence, CAN suspicion and reporting must be thoughtfully considered.…”

“…Research is attempting to understand the racial disparities (Kokaliari et al, 2019), biases (Drake et al, 2011) and the overrepresentation American Indian or Alaska Natives and African American children within the child welfare system (US DHHS, 2023), as well how poverty and social disadvantage play a significant role in foster care placement (Wulczyn et al, 2013(Wulczyn et al, , 2023. Berkman et al (2022) urges CAN mandated reporters to consider the historical context of systemic racism and how reporting can cause more harm to the child; hence, CAN suspicion and reporting must be thoughtfully considered.…”