Funded Projects

A Pediatrician's Role in Addressing Racism

Project Year

2022

City & State

San Antonio, Texas

Program Name

CATCH Resident

Topic

Health Disparities

Program Description

San Antonio Uniformed Services Health Education Consortium (SAUSHEC) pediatrics residency program is located in San Antonio, Texas. In 2019, San Antonio rivaled Miami for the country’s poorest metropolitan area with nearly 14% of residents living below the poverty line¹. As is often the case, poverty and racism tend to coexist and San Antonio declared racism a public health crisis for the city in August of 2020². While our pediatric residency is a military program, our patients and patients' families are very much members of the surrounding community, often coping with poverty, hunger, and discrimination. While active military members have steady income and access to health insurance, a high rate of young enlisted families report food insecurity as well as difficulty in accessing mental health resources in an environment where many providers no longer accept military health insurance and have transitioned to cash-based services. While the overall military seems to match, or exceed, the civilian population in terms of racial and ethnic diversity, that is not the case for commissioned officers and physicians. In this more educated population, demographics are skewed toward White leaders, with 73% of officers that are White, 8% that are Black, and 8% that are Hispanic³. There is a mounting body of evidence that supports that racism and experiences with discrimination have a negative impact on minoritized children’s development and health. In 2019, the AAP put out a call for pediatricians to address and ameliorate the negative impacts of structural racism, highlighting the importance for provider preparedness to discuss the topic in a meaningful way with their patients⁴; however, there is little research describing how that can be done. By using a community-based participatory research framework, this project will make connections within our local community, including military health clinics, school outreach, and youth centers/daycares, and work directly with community members and their families to determine how, and in what ways, the pediatric medical team could best address the intersection of racism/discrimination and its effect on patients health outcomes. With this foundational information, we can then delve further into the community-based participatory research model to develop and implement further interventions to improve the ability of the pediatrician, and the child’s medical home, to address and prevent the poor health outcomes associated with racism and discrimination. As themes emerge from family focus-group interviews, information can then be shared with the community to help engage the schools and daycare setting within the local community, to better enhance support and impede inequities even outside the physician’s office. Additionally, information gained from family focus groups could inform a multi-disciplinary program, involving community leaders along with pediatric and mental health care providers, to establish and implement group sessions and support where community members can appropriately address their experiences and improve health outcomes.

Project Goal

The goal of this qualitative study is to explore how pediatricians and the medical team should discuss the subject of racism/discrimination and the development of a child’s racial identity based on the perspective of minoritized pediatric-aged patients and their parents.

Project Objective 1

Conduct semi-structured interviews/family interviews and focus groups with up to 25 families that self-identify as a racial/ethnic minority to gain patient-driven perspectives on best learn best practices for the pediatric medical team pediatric providers to address and discuss issues of racism and discrimination and racial identity development with their minoritized patients

Project Objective 2

Recruit members and leaders within our local community to collaborate with pediatric providers and researchers (including, but not limited to: Fort Sam Houston youth center/daycares, Fort Sam Houston School District, Child and Adolescent Family Behavioral Health Clinic, Cap4Kids)

Project Objective 3

Identify resources and interventions desired by the community to alleviate the effects of racism and discrimination in children and adolescents and provide support to innovate and implement these measures (including, but not limited to: easy access to mental health support through support groups, online/written resources for assisting families and health care providers with racial identity formation and racism)

AAP District

District VII

Institutional Name

Brooke Army Medical Center

Contact 1

Samantha Rowden