Racial and Ethnic Disparities and Bias in the Evaluation and Reporting of Abusive Head Trauma

Abstract

Significant race/ethnicity-based disparities in AHT evaluation and reporting were observed at only 2 of 18 sites and occurred almost exclusively in lower risk patients. In the absence of local confounders, these disparities likely represent the impact of local physicians' implicit bias.

Do Racial Stereotypes Contribute to Medical Misdiagnosis of Child Abuse?

“…This is notable as it provides empirical evidence that race affects the way families are evaluated in the medical context, with Black parents receiving greater scrutiny and consideration relative to their White counterparts, even when all other facts are held constant. This is in line with studies suggesting that medical professionals are more likely to look for evidence of abuse in cases involving Black rather than White children (Lane et al, 2002), even when the children have the exact same symptoms (Zellman, 1992), and even when suspicion of abuse may be unfounded (Hymel et al, 2018).…”

“…It remains to be seen whether policy safeguards should also be implemented to reduce the likelihood that medical professionals' biased information-processing translates into misdiagnosis of abuse. There has been at least enough evidence of racial disparities in this outcome (e.g., Hymel et al, 2018;Zellman, 1992) to show the need for reviews within the child welfare system to better understand why it occurs, and why it has sometimes led to wrongful convictions in the criminal justice system (e.g., People v. Thomas, 2014). Now that we have shined a light on this problem, we hope that researchers, medical professionals, and policymakers will continue to identify the issues that contribute to it and work to develop solutions.…”

“…For example, a retrospective chart review of infants and toddlers who were hospitalized for skull or long-bone fractures showed that children were more likely to be subjected to a skeletal survey and reported to child protective services for suspected abuse if they were Black or Hispanic rather than White (Lane et al, 2002). In a more recent study, Hymel et al (2018) concluded that disparities in the rates of evaluating and reporting young children for abusive head trauma in pediatric intensive care units manifested only among children who were not ultimately classified as having experienced abuse; no similar racial difference emerged among children who were determined to be abuse victims. An experimental study of mandated reporters yielded similar results.…”

Assessing, Consulting, Reporting Heuristics in Professional Decision-Making Regarding Suspected Child Maltreatment in Community Healthcare Services

“…Our studies show that social workers are more likely to assess higher risk of future harm and to recommend out-of-home care when the child’s family is of Middle Eastern ethnic origin, as opposed to European, or if the family has a lower SES (Enosh & Bayer-Topilsky, 2014; Enosh et al, 2019). Studies on the decision-making practices of HCPs in hospital settings, using structured questionnaires, a review of the hospitals’ documents, and secondary analysis of medical datasets, show that minority children or children of low-SES families are more likely to be diagnosed and reported to child protection services for suspected abuse (Benbenishty et al, 2011; Hymel et al, 2018; King et al, 2015; Lane et al, 2002; Najdowski & Bernstein, 2018; Wood et al, 2010).…”

Bias and Objectivity When Evaluating Social Risk Factors for Physical Abuse: of Babies and Bathwater

“…In this volume of The Journal , Hymel et al present significant race-based disparities in the evaluation and reporting of young children admitted to a pediatric intensive care unit for traumatic brain injury. 6 Even though the rate of abuse was nearly 50% in this cohort, many children did not undergo a skeletal survey, and many were not reported to Child Protective Services (CPS); these decisions were significantly associated with race in 2 of the 18 participating centers. The data presented by Hymel et al cannot tell us whether this finding was the result of bias, or whether the outcome merely reflects continued associations in our society between race and social factors that truly predict abuse.…”