Structural Harm In Pediatric Settings: Mandated Reporting, Medical Practices, and Black Familial Health

Background and Purpose: Data across numerous jurisdictions in the United States report Black parents receive disproportionately high child protective services reports from health care providers (Berkman et al, 2022; Roberts et al, 2024). Utilizing mandated reporting as a tool, physicians are a primary driver of the racial disparities in the child welfare system, resulting in a cascading effect, impacting racial disparities at every other decision point in the child welfare system (Rosenthal, et al., 2022).

Despite extensive research on racial bias in the child welfare system and health inequities impacting the Black community, no studies to date have explored the experience of Black parents’ medical decisions surrounding adherence for their children considering mandated reporting practices by health professionals.

Utilizing Structural and Benevolent Theory (SBV) as foreground for understanding the experience of surveillance and harm Black parents have historically endured from institutional harms, this study explores how Black parents understand and experience mandated reporting policies in pediatric settings and how their experiences affect medical adherence.

Methods: 31 Black parents participated in semi‑structured virtual interviews detailing their knowledge of mandated reporting, their experiences, and the impact of mandated reporting on their medical decisions. Participants were recruited via (a) social media outlets, and (b) email communication with local community organizations. Utilizing thematic analysis, six themes emerged: (1) shared knowledge of reporting by physicians, (2) feeling judged by physicians, (3) the need for mandated supporting over mandated reporting, (4) mandated reporting’s influence on medical decision-making, (5) physician bias, and (6) the value of physician racial identity.

Results: Findings illustrate that physician interactions associated with mandated reporting affects medical decision-making of Black parents. Our findings indicate that mandated reporting serves as a mechanism of structural harm to Black families and the Black community. Participants acknowledged the importance of protecting children and stressed the need for reforms that mitigate racial bias, systemic racism, and promote supportive mandated reporting. Additionally, advocacy is healing and by engaging in this study, Black parents shared their hope for change and a sense of accomplishment in the possibility of the researchers being able to enact change.

Conclusions and Implications: This study aligns with current movements to amend mandated reporting laws at the state and federal level to support families rather than penalize them. By centering the realities of Black parents regarding the effects of mandated reporting by physicians, this study advances rigorous, qualitative inquiry in the fields of health and child welfare. The strength of this research is the illumination of the under-researched intersection between child welfare policy, medical practices associated with mandated reporting, and Black healthcare decisions, emphasizing the urgent need for structural and practice-level changes. Furthermore, this study may serve to prod the medical and child welfare systems to mitigate the infliction of ongoing institutional trauma thus, providing space for the Black community to thrive physically and mentally without the continued threat of oversurveillance by physicians who have taken an oath to ‘do no harm.’