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Child welfare system fraught with bias: What pediatricians can do

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Editor's note:  For more coverage of the 2022 AAP National Conference & Exhibition, visit

Numerous studies have identified disparities in the outcomes of racial and ethnic minorities within the child welfare and judicial systems, said Hannah B. Barber Doucet, M.D., M.P.H., FAAP. These disparities include increased rates of case substantiation, child removal and prosecution as well as harsher punishments.

“Studies also suggest that for racial/ethnic minorities who seek medical care, provider implicit bias can lead to disparities at the level of medical evaluation with consequences such as increased rates of evaluation for abuse, diagnosis of abuse and referral to authorities for suspected maltreatment,” said Dr. Doucet, assistant professor in the Department of Pediatrics at Boston Medical Center/Boston University School of Medicine.

To raise awareness of these disparities and discuss how to address them, Dr. Doucet will lead a session with Tiffani J. Johnson, M.D., M.Sc., FAAP, assistant professor of emergency medicine at University of California, Davis, and a member of the AAP Section on Minority Health, Equity and Inclusion.

The session “Understanding and Overcoming Biases in the Child Welfare System” (S2414) will be held from 2-3 p.m. PDT Saturday, Oct. 8 in rooms 257.5-260 of the convention center.

“All pediatricians have a responsibility to accurately diagnose and report concerns for abuse,” Dr. Doucet said. “They also have a responsibility to limit the potential damage of biased decision-making.”

A pediatric emergency medicine (PEM) physician, Dr. Doucet and her colleagues often are charged with evaluating children for abuse and working with the child welfare system when they are concerned about abuse.

In addition, she is involved in medical education on bias and racism, teaching providers about the impact of racism in pediatric and adult emergency medicine and mitigation techniques.

“Evaluation for nonaccidental trauma is one of the many places we have seen an impact of bias in PEM and so naturally it became part of my interest and teaching,” said Dr. Doucet.

During the session, Drs. Doucet and Johnson, who are members of the AAP Section on Emergency Medicine, will discuss what implicit bias is and how it impacts medical decision-making. They also will describe potential biases that impact the child welfare system and how providers can mitigate bias and racism in their care of patients.

“Whether pediatricians are still in training or have leadership roles that can create structural change, they will be able to bring home self-reflection and new skills from this session,” Dr. Doucet said.

For more information on the National Conference, visit View the conference schedule at

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