Docs more likely to suspect abuse in poor kids

By Amy Norton - Reuters

(Reuters Health) - When a toddler has a broken bone, pediatricians may be more likely to suspect abuse if the family is lower-income, a new study finds.

Researchers found that pediatricians who read a fictional case report of a toddler with a leg fracture were more likely to suspect abuse if the child was described as coming from a lower-income family.

The hypothetical child's race, on the other hand, did not appear to influence doctors' opinions.

The second finding is somewhat surprising, according to the researchers. Studies looking at real-world cases have found that minority children are more likely to be evaluated for abuse than white children are.

And it's well known that the child welfare system in the U.S. has a disproportionate number of minority kids.

"There's very strong evidence of a racial difference in how patients are handled," said lead researcher Dr. Antoinette L. Laskey, a pediatrician at the Indiana University School of Medicine in Indianapolis.

But, she told Reuters Health, the reasons for that have not been clear -- including whether doctors may act based on unconscious racial stereotypes.

The current results suggest "there's more than race involved," Laskey said.

She was also quick to say, however, that the study doesn't mean pediatricians are consciously "classist" or otherwise biased when evaluating children's injuries.

The study, reported in the Journal of Pediatrics, included 2,100 U.S. pediatricians who responded to a survey that described one of four hypothetical cases.

All cases included an 18-month-old with an "ambiguous" leg fracture -- a type that can be caused by abuse or an accident.

But the cases varied by the child's race (black or white) and the family's economic situation; parents were described as having either professional jobs (accountant and bank manager) or working-class jobs (grocery clerk and factory worker).

Race had little effect on the doctors' responses. The study found that when the child was black, 45 percent of doctors believed there had "possibly" or "almost certainly" been abuse; another 32 percent were "unsure." If the child was white, 46 percent of pediatricians suspected abuse, with 28 percent saying they were unsure.

In contrast, there was evidence that parents' job descriptions swayed doctors' opinions.

When the child's family was lower-income, 48 percent of pediatricians thought there'd been abuse, versus 43 percent when the family was higher-income.

It's hard to know whether doctors' responses to a fictional case would be the same in real life.

And it's not clear, according to Laskey, whether attitudes about socioeconomic status might explain some of the racial differences in child abuse reporting seen in earlier studies.

She also stressed that she does not think pediatricians are consciously basing their diagnoses on parents' job titles. But in general, unconscious stereotypes can influence anyone's thinking.

"People tend to think that child abuse, or domestic violence, doesn't happen in upper-middle-class families, but of course it does," Laskey said.

It's important, she said, for doctors to be aware that unconscious generalizations could get in the way of diagnosing child abuse -- either missing it in kids from affluent families, or over-diagnosing it in children from poorer or minority families.

"My big take-home message for doctors is that we need to rely on the objective data," Laskey said.

It is true that studies have found children in poorer families to be at greater risk of abuse. But the poverty, itself, is not a "causative factor," Laskey said.

"Race and socioeconomic status shouldn't be things used in a diagnosis of abuse," she said.

SOURCE: Journal of Pediatrics, online January 5, 2012.

Source http://www.reuters.com/article/2012/01/20/us-docs-abuse-idUSTRE80J1WK20120120

Race A Major Factor In Foster Care Disparities

Written by Larry Aubry, (Columnist), on 08-29-2011 13:19

In Los Angeles and across the nation, there are clear disparities in foster care and Black children are faring far worse than their white counterparts. For Los Angeles Congresswoman Karen Bass, foster care reform has long care a top priority. She has repeatedly introduced legislation to increase foster care funding and the quality of services. Bass' efforts focus attention on the need to provide adequate resources as well as on race-based disparities that harm countless children. (A poignant and distressing example of the magnitude of the foster care problem is Los Angeles' predominantly Black Crenshaw High School- almost half of its students are in foster homes.)

The following excerpts are from a paper by the Annie E. Casey Foundation, whose primary mission is fostering public policies, reforms and community support that more effectively meet the needs of vulnerable children and families.

It is time to focus on disparities faced by African American children in our country's foster care system. Contrary to post-racial society rhetoric, race still weighs heavily on unification and permanence for foster kids. Children of color, especially African American children, fare far worse than whites on measures such as placement in foster care, length of stay in foster care, number of moves in foster care and length of time to permanency.

African American children, more than any other group, are more likely to exit the foster care system without being adopted, although a permanent home is the right of every child. The president of the Annie E. Casey Foundation says, "The basic human need for a family connection that can be counted on for life must be recognized as essential for all children and families, including those who interact with a child welfare system."

According to a 2007 Government Accountability Office report, African American children stay in foster care longer because of difficulties in recruiting adoptive parents and greater reliance on relatives to provide foster care who may be unwilling to terminate the parental rights as the child's parent or who, disproportionately, may need the financial subsidy they receive while the child is in foster care.

Research shows that African American children are no more likely to experience maltreatment than white children, yet they are greatly overrepresented among the child welfare population, especially while in foster care. Child maltreatment reports for children of color are also more likely to be confirmed than reports for white children.

African American children are also more likely to languish in foster care despite research proving that there is no real difference in the overall incidents of child abuse and neglect between African American and white children within similar income groups. Even for infants, disparities face African American in foster care and they are less likely to experience unification than white infants. Further, African American children over ten-years of age are significantly less likely to return home than white youth.

Practice and policy recommendations: Change federal fiscal policy to better promote permanence and well-being. To make a difference in child welfare outcomes, the federal government should have to right the balance between funds dedicated solely to out-of-home care and those that can be used more flexibly to keep families together.

Promising proposals include: Giving states the option of receiving funds solely for out-of-home care in exchange for more flexible and innovative funding that can be used to prevent out-of-home placement, while limiting states' financial risks if child welfare caseloads increase. The federal government must also take a leadership role in reducing pervasive racial disparities found throughout the child welfare system. Children of color are more likely than white children to be placed in foster care, less likely to receive the services they need and more likely to remain in care for a long time, even when the effects of poverty and thy type of maltreatment alleged are taken into account.

Child welfare information systems remain a generation behind the times, hampering efforts at all levels to track and improve performance. The federal government must support the development and dissemination of new information technologies for child welfare, combining mobile computer capability with worker-level decision support tools and proven practice guides.

Concerned citizens, African Americans especially, should urge their congressional delegations to vote for Bass's pending foster care bill- it represents an important step toward actual reform. And broad dissemination of the kind of information presented here, pressure on public administrators and elected officials and collaborating with families and interested others, are indispensable for sustainable foster-care reform.

Source http://www.lasentinel.net/RACE-A-MAJOR-FACTOR-IN-FOSTER-CARE-DISPARITIES.html