Structural Racism in Behavioral Health Presentation and Management.

Nia is a first-grade student with a history of trauma who was brought in by ambulance to the pediatric emergency department for "out of control behavior" at school. This is the first of multiple presentations to the emergency department for psychiatric evaluation, stabilization, and management throughout her elementary and middle school years. Several of the visits resulted in admission to the inpatient pediatric service, where she "boarded" while awaiting transfer to an inpatient psychiatric facility. At times, clinical teams used involuntary emergency medications and physical restraints, as well as hospital security presence at the bedside, to control Nia's behavior. Nia is Black and her story is a case study of how structural racism manifests for an individual child. Her story highlights the impact of adultification bias and the propensity to mislabel Black youth with diagnoses characterized by fixed patterns of negative behaviors, as opposed to recognizing normative reactions to trauma or other adverse childhood experiences-in Nia's case, poverty, domestic violence, and Child Protective Services involvement. In telling Nia's story, we (1) define racism and discuss the interplay of structural, institutional, and interpersonal racism in the health care, education, and judicial systems; (2) highlight the impact of adultification bias on Black youth; (3) delineate racial disparities in behavioral health diagnosis and management, school discipline and exclusion, and health care's contributions to the school-to-prison pipeline; and finally (4) propose action steps to mitigate the impact of racism on pediatric mental health and health care.

The dual pandemics of COVID-19 and racism: impact on early childhood development and implications for physicians.

PURPOSE OF REVIEW: The novel coronavirus (COVID-19) pandemic has highlighted healthcare and racial inequities. This article discusses recent literature documenting the impact of racism on early childhood development, disparities in access to developmental services and ways healthcare providers and health systems can promote physician well being during these difficult times. RECENT FINDINGS: Exposure to racism begins prenatally, and early childhood experiences with racism are intimately tied to adverse physical and mental health outcomes. Early intervention is key to treating children with developmental delay, but disparities exist in accessing eligibility screening and in the provision of services. Paediatric providers are at risk of developing secondary traumatic stress and burnout, which may affect the care that they provide. SUMMARY: New research has led to the development of resources that help paediatric providers address racism, access developmental resources in a novel manner and protect the paediatric workforce from trauma and burnout.

A Trainee-Led Social Media Advocacy Campaign to Address COVID-19 Inequities.

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on the health of people globally. Yet, not all people are being affected by this crisis equally. In the United States, this pandemic has exacerbated long-standing inequities and entrenched structural racism. At the onset of the crisis, few data were available detailing the demographic characteristics of individuals with COVID-19. However, as data emerged, it became apparent that communities of color were disproportionately affected. To illustrate these inequities, we analyzed publicly available race and ethnicity data on COVID-19 cases and deaths and were one of the first groups to compile these findings. We launched a social media campaign to highlight these racial and ethnic inequities and raise awareness among public and elected officials. Given the tremendous amount of missing data, we demanded transparency in state reporting of race and ethnicity data. Using both messaging and mapping tools, we publicized state and city efforts to address these inequities, focusing on the creation of task forces tackling the racial inequities of COVID-19. As racial and ethnic data on COVID-19 cases and mortality became more widely reported, statistics emerged about the downstream effects of these inequities. Despite initial false reassurance that COVID-19 largely spared children, the pandemic has exacerbated many social needs, leading to significant negative impacts on children. For example, as pediatricians, we saw how worsening food insecurity was affecting children. Using social media and infographics, we launched an additional stage of the campaign to illustrate these inequities and highlight advocacy opportunities.

Health Equity Rounds: An Interdisciplinary Case Conference to Address Implicit Bias and Structural Racism for Faculty and Trainees.

Introduction: The medical community recognizes the importance of confronting structural racism and implicit bias to address health inequities. Several curricula aimed at teaching trainees about these issues are described in the literature. However, few curricula exist that engage faculty members as learners rather than teachers of these topics or target interdisciplinary audiences. Methods: We developed a longitudinal case conference curriculum called Health Equity Rounds (HER) to discuss and address the impact of structural racism and implicit bias on patient care. The curriculum engaged participants across training levels and disciplines on these topics utilizing case-based discussion, evidence-based exercises, and two relevant conceptual frameworks. It was delivered quarterly as part of a departmental case conference series. We evaluated HER's feasibility and acceptability by tracking conference attendance and administering postconference surveys. We analyzed quantitative survey data using descriptive statistics and qualitatively reviewed free-text comments. Results: We delivered seven 1-hour HER conferences at our institution from June 2016 to June 2018. A mean of 66 participants attended each HER. Most survey respondents (88% or more) indicated that HER promoted personal reflection on implicit bias, and 75% or more indicated that HER would impact their clinical practice. Discussion: HER provided a unique forum for practitioners across training levels to address structural racism and implicit bias. Our aim in dissemination is to provide meaningful tools for others to adapt at their own institutions, recognizing that HER should serve as a component of larger, multifaceted efforts to decrease structural racism and implicit bias in health care.

Addressing Pediatric Obesity in Ambulatory Care: Where Are We and Where Are We Going?

Since the "2007 summary report of child and adolescent overweight and obesity treatment" published by Barlow, many obesity intervention studies have been conducted in pediatric ambulatory care. Although several meta-analyses have been published in the interim, many studies were excluded because of the focus and criteria of these meta-analyses. Therefore, the primary goal of this article was to identify randomized case-control trials conducted in the primary care setting and to report on treatment approaches, challenges, and successes. We have developed four themes for our discussion and provide a brief summary of our findings. Finally, we identified major gaps and potential solutions and describe several urgent key action items.