Pub Date : 2024-09-01DOI: 10.1016/j.acap.2023.08.006
{"title":"Stress of Being Underrepresented in Academic Pediatrics","authors":"","doi":"10.1016/j.acap.2023.08.006","DOIUrl":"10.1016/j.acap.2023.08.006","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.acap.2023.11.004
We open this article by asking you to consider that the magnitude of racism present in clinical spaces is much larger and more in depth than we can ever begin to cover. In this spirit, we are going to provide you with some context to think about the problem of racism and mental health and disability and ways to deconstruct the problem through the lens of structural violence and structural racism. We offer you a brief discussion on and a definition of structural violence and structural racism and then tie them to two case studies to help contextualize how racism currently exists within the medical field. We hope that the language and framework of structural violence and structural racism will help you think anew about racism and your own interactions with it. Although the difficulties with racial and structural violence are much too pervasive and will take collective action to dismantle, we do think that giving a framework to think and talk about racism may help the ways that you choose to interact with your patients, engage in clinical assessments, diagnosis, treatment, and navigate systems from your current role within the medical field.
{"title":"(Re)assessing Clinical Spaces: How do we Critically Provide Mental Health and Disability Support and Effective Care for Black and Brown Young People who are Impacted by Structural Violence and Structural Racism?","authors":"","doi":"10.1016/j.acap.2023.11.004","DOIUrl":"10.1016/j.acap.2023.11.004","url":null,"abstract":"<div><div>We open this article by asking you to consider that the magnitude of racism present in clinical spaces is much larger and more in depth than we can ever begin to cover. In this spirit, we are going to provide you with some context to think about the problem of racism and mental health and disability and ways to deconstruct the problem through the lens of structural violence and structural racism<span>. We offer you a brief discussion on and a definition of structural violence and structural racism and then tie them to two case studies to help contextualize how racism currently exists within the medical field. We hope that the language and framework of structural violence and structural racism will help you think anew about racism and your own interactions with it. Although the difficulties with racial and structural violence are much too pervasive and will take collective action to dismantle, we do think that giving a framework to think and talk about racism may help the ways that you choose to interact with your patients, engage in clinical assessments, diagnosis, treatment, and navigate systems from your current role within the medical field.</span></div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.acap.2024.07.012
{"title":"A Future Where Children and Their Families’ Health Is No Longer a Privilege but a Right","authors":"","doi":"10.1016/j.acap.2024.07.012","DOIUrl":"10.1016/j.acap.2024.07.012","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.acap.2024.07.010
{"title":"Racism and Pediatrics: Finding a Way Forward to Advance Child Health","authors":"","doi":"10.1016/j.acap.2024.07.010","DOIUrl":"10.1016/j.acap.2024.07.010","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.acap.2023.08.005
Health financing for children and youth comes mainly from commercial sources (especially, a parent’s employer-sponsored insurance) and public sources (especially, Medicaid and Children’s Health Insurance Plan [CHIP]). These 2 sources serve populations that differ in race and ethnicity. This inherent segregation perpetuates a system of disparities in health and health care. Medicaid (and CHIP) have become the largest single provider of health insurance to US children and youth, currently insuring over 50% of all children and youth, with even higher rates for children of racial and ethnic minorities. Medicaid provides substantial benefit to the populations it insures, with good evidence of both short- and long-term improved health and developmental outcomes, and better health and well-being as adults. Nonetheless, some characteristics of Medicaid, especially the major state-by-state variation in eligibility, enrollment practices, and covered services, along with persistent low payment rates, have helped to maintain a separate and unequal health program for racial and ethnic minority children and youth. Several changes in Medicaid—including linking CHIP more closely with Medicaid, strengthening national standards of payment and care, assuring coverage of all children, and incorporating social and family risk adjustment—could make the program even more beneficial and diminish racial differences in child health financing.
{"title":"How Child Health Financing and Payment Mitigate and Perpetuate Structural Racism","authors":"","doi":"10.1016/j.acap.2023.08.005","DOIUrl":"10.1016/j.acap.2023.08.005","url":null,"abstract":"<div><div>Health financing for children and youth comes mainly from commercial sources (especially, a parent’s employer-sponsored insurance) and public sources (especially, Medicaid and Children’s Health Insurance Plan [CHIP]). These 2 sources serve populations that differ in race and ethnicity. This inherent segregation perpetuates a system of disparities in health and health care. Medicaid (and CHIP) have become the largest single provider of health insurance to US children and youth, currently insuring over 50% of all children and youth, with even higher rates for children of racial and ethnic minorities. Medicaid provides substantial benefit to the populations it insures, with good evidence of both short- and long-term improved health and developmental outcomes, and better health and well-being as adults. Nonetheless, some characteristics of Medicaid, especially the major state-by-state variation in eligibility, enrollment practices, and covered services, along with persistent low payment rates, have helped to maintain a separate and unequal health program for racial and ethnic minority children and youth. Several changes in Medicaid—including linking CHIP more closely with Medicaid, strengthening national standards of payment and care, assuring coverage of all children, and incorporating social and family risk adjustment—could make the program even more beneficial and diminish racial differences in child health financing.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.acap.2023.11.022
{"title":"Language Matters: Language Inclusivity in Pediatric Health Care","authors":"","doi":"10.1016/j.acap.2023.11.022","DOIUrl":"10.1016/j.acap.2023.11.022","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.acap.2023.06.027
{"title":"We are the Witnesses: Structural Racism and Divestment in Children","authors":"","doi":"10.1016/j.acap.2023.06.027","DOIUrl":"10.1016/j.acap.2023.06.027","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.acap.2023.08.009
This narrative review examines the impact of racism in academic pediatrics. We begin with our challenges in diversifying the pediatric physician workforce and the downstream impact of selection and recruitment practices compounded by disparities in resident dismissal rates. We present best practices in recruitment and resources from academic societies and institutions, including examples of successful holistic review processes. We then shift our focus to the effect of racism on the clinical learning environment and the use of race in curricular materials, clinical research reports, and practice guidelines. We discuss the need to create new guidelines for the inclusion of race in teaching materials and strategies to teach residents to critically interrogate clinical practice guidelines. Ultimately, we examine how racism impacts retention for faculty. We present the demographics of underrepresented in medicine faculty, the impact of racism in the work environment on attrition and mentorship, and where national programs are working to fill the gaps.
{"title":"Impact of Racism on the Diversification of the Pediatric Workforce","authors":"","doi":"10.1016/j.acap.2023.08.009","DOIUrl":"10.1016/j.acap.2023.08.009","url":null,"abstract":"<div><div>This narrative review examines the impact of racism in academic pediatrics. We begin with our challenges in diversifying the pediatric physician workforce and the downstream impact of selection and recruitment practices compounded by disparities in resident dismissal rates. We present best practices in recruitment and resources from academic societies and institutions, including examples of successful holistic review processes. We then shift our focus to the effect of racism on the clinical learning environment and the use of race in curricular materials, clinical research reports, and practice guidelines. We discuss the need to create new guidelines for the inclusion of race in teaching materials and strategies to teach residents to critically interrogate clinical practice guidelines. Ultimately, we examine how racism impacts retention for faculty. We present the demographics of underrepresented in medicine faculty, the impact of racism in the work environment on attrition and mentorship, and where national programs are working to fill the gaps.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.acap.2024.02.009
Adolescence is a critical developmental stage for young people as they transition into adulthood. Several important developmental tasks that must be completed during this transition include exploring one’s identity, developing and applying abstract thinking, adjusting to a new physical sense of self, and fostering stable and productive peer relationships while striving for autonomy and independence from parents. Young people begin to adopt a personal value system and form their racial and ethnic, social, sexual, and moral identity within a society that may provide conflicting and nonaffirming messages. Adolescent development strives toward an affirmed sense of self and self-esteem, which is best accomplished within a nurturing psychosocial context that fosters positive youth development. Youth-focused interventions should intentionally promote affirmation of ancestry and cultural identity, intersections with other historically marginalized identities, and critical consciousness. Fostering healing environments that affirm and address the radical need for change, coaching parents and guardians as critical agents in the creation of affirmative environments for development, and conducting research using anti-oppressive approaches are additional strategies to promote positive youth development. Simultaneously, structural transformations that address underlying social inequities are needed. Health care systems should continue to diversify the workforce and train staff and clinicians in integrative, identity-based, and healing-centered approaches. Organizations should consider training in diversity and competencies related to belonging while safeguarding inclusion with policies, procedures, and practices. Public health and policymakers can embed intersectional approaches within structural and systemic processes, particularly in all policies.
{"title":"Racism, Identity-Based Discrimination, and Intersectionality in Adolescence","authors":"","doi":"10.1016/j.acap.2024.02.009","DOIUrl":"10.1016/j.acap.2024.02.009","url":null,"abstract":"<div><div>Adolescence is a critical developmental stage for young people as they transition into adulthood. Several important developmental tasks that must be completed during this transition include exploring one’s identity, developing and applying abstract thinking, adjusting to a new physical sense of self, and fostering stable and productive peer relationships while striving for autonomy and independence from parents. Young people begin to adopt a personal value system and form their racial and ethnic, social, sexual, and moral identity within a society that may provide conflicting and nonaffirming messages. Adolescent development strives toward an affirmed sense of self and self-esteem, which is best accomplished within a nurturing psychosocial context that fosters positive youth development. Youth-focused interventions should intentionally promote affirmation of ancestry and cultural identity, intersections with other historically marginalized identities, and critical consciousness. Fostering healing environments that affirm and address the radical need for change, coaching parents and guardians as critical agents in the creation of affirmative environments for development, and conducting research using anti-oppressive approaches are additional strategies to promote positive youth development. Simultaneously, structural transformations that address underlying social inequities are needed. Health care systems should continue to diversify the workforce and train staff and clinicians in integrative, identity-based, and healing-centered approaches. Organizations should consider training in diversity and competencies related to belonging while safeguarding inclusion with policies, procedures, and practices. Public health and policymakers can embed intersectional approaches within structural and systemic processes, particularly in all policies.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142480015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01DOI: 10.1016/j.acap.2023.07.017
{"title":"A Research Agenda on Anti-Racism in Child and Adolescent Health","authors":"","doi":"10.1016/j.acap.2023.07.017","DOIUrl":"10.1016/j.acap.2023.07.017","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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