Addressing Health Disparities

Health disparities are linked to

forces outside the healthcare system (systemic / structural injustice and inequity; social determinants of health) and
factors inside the healthcare system (i.e., day-to-day practices by healthcare providers and clinical teams).

Research has documented disparities in care based on race / ethnicity or language that could impact children’s risk for medical traumatic stress. One example is the way in which pain is recognized and managed. Studies have found:

Black children in the ED were less likely than White children with similar pain ratings to receive analgesic medication (Johnson et al., 2013).
Children whose parents had limited English language proficiency had their pain assessed less frequently after surgery and experienced greater pain levels before receiving analgesic medication (Jimenez et al., 2014).

How does this relate to trauma-informed care for children?

Structural and systemic inequities lead to greater trauma exposure and traumatic stress.

Systemic inequities – such as racism, homophobia, sexism – put some children and families at higher risk of adverse and traumatic experiences that can impact their overall health and well-being, and the way they experience healthcare and new medical events.

Bias in healthcare interactions and decision-making can increase traumatic aspects of pediatric illness, injury, and healthcare.

A growing body of research has demonstrated that healthcare professionals often exhibit implicit (i.e., unconscious) biases based on patients’ race or ethnicity – even for pediatric patients -- and that these biases impact clinical care.

Illness, injury, and treatment are more likely to be traumatic when pain management is hampered, or when children and families do not experience respectful, attuned, trustworthy communication with the healthcare team.

How can healthcare providers address health disparities and support trauma-informed care?

Healthcare systems and healthcare professionals have a key role to play in addressing inequities in healthcare delivery. To actively combat the impact of health disparities on trauma-informed pediatric care, healthcare professionals can:

Take concrete steps to acknowledge their own susceptibility to implicit biases and work to change these.
Work with colleagues to implement policies and practices in the clinical setting that guard against bias.
When caring for children and families with limited English proficiency, collaborate effectively with medical interpreters throughout clinical care.
Engage as citizens and community members to eliminate systemic / structural racism and other inequities.

Resources

Grand Rounds presentation: Implicit Racial Bias in Health Care - Tiffani Johnson, MD, MSc.
American Academy of Pediatrics Statement on Racism on Child and Adolescent Health
Nursing: Racism in Healthcare
Race and Medicine - comprehensive set of resources and learning tools
National Child Traumatic Stress Network (NCTSN) infographic for providers on Cultural Responsiveness to Racial Trauma

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Pediatric Medical Traumatic Stress

Patient Education

Screening & Assessment

Intervention

Trauma-Informed Care

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