Surveillance Disguised As Care: The Policing of Black Families In Pediatric Settings

Background and Purpose: Scholars have consistently studied the racist origins of the child welfare system and asserted that child welfare is an institution that polices, disrupts, and separates Black families. The oversurveillance of Black families has resulted in stark differences in the rate of child welfare contact between Black and white families, with more than half of Black children experiencing a child welfare investigation (Kim et al., 2017). Beginning with reporting, oversurveillance results in disadvantages and poor outcomes for Black families at almost every decision-making point in child welfare (Wright et al., 2022). The medical system, a primary entry point for numerous child abuse and neglect investigations, is a primary driver of the policing of Black families. Yet, researchers have failed to examine if current mandated reporting practices in pediatric settings impact medical adherence by Black parents. This study addressed this gap by exploring the relationship between mandated reporting to child welfare systems and medical adherence among Black parents’ medical decisions on behalf of their children.

Methods: Thirty-one in-depth, semi-structured interviews of Black mothers and fathers were used to explore Black parent’s experiences in pediatric settings related to mandated reporting. Employing an Africana Womanist theoretical lens, the interviews were analyzed and coded using thematic analysis. Participants were recruited via (a) social media outlets (e.g. Instagram), and (b) email communication with local community organizations

Results: Data analysis resulted in the emergence of three key themes: 1) systemic racism 2) misogynoir, and 3) trauma. Findings suggest that mandated reporting by physicians impacts the medical decisions of Black parents. The analysis supports the existence of a traumatic impact of mandatory reporting on Black families. Contributing to the traumatic impact of interactions, Black parents recognized the manifestations of systemic racism. Additionally, Black mothers recognized misogynoir at play in during interactions with physicians. The findings indicate that physicians in their role as mandated reporters represent a threat to the well-being of Black parents and hence the Black family.

Conclusions and Implications: Consistent with the tenets of African Womanism, this study stresses the importance of the well-being of Black women and the Black family.

Considering the dangers of mandated reporting as a vehicle for structural harm to the Black family and community, this rigorous, qualitative study highlights the understudied intersection of the child welfare system and the medical system- two entities in which Black families experience gross disparities and disproportionalities.

Numerous factors including anti-Blackness, has prevented the medical and child welfare systems from thoroughly discussing, researching, and addressing the systemic harm to Black children, families, and communities despite the acknowledge of harm from both systems. The study emphasizes the need for reforms to child welfare mandated reporting policies and the integration of anti-racist, trauma-informed, and family-affirming approaches within pediatric healthcare to mitigate harm to Black families. Research such as this, lifting the voices of Black parents, has the potential to remove issues impacting Black families from the margins to center page. Thus, propelling researchers and physicians to work towards mitigating the harm to Black parents.