Research In Practice Blog
A 16-year-old patient walks into the pediatrician’s office. They’re excited for the independence driving will bring. Their mom brings up concerns about him being pulled over, worried about the potential outcome because her son is Black… As pediatricians, anticipatory guidance is our bread and butter. But discussing with patients how to feel safe during police interactions isn’t a standard lesson covered in medical school or on the pediatric wards.
Police killings of and violence towards Black male youth and young adults compared to white male youth and young adults remain a striking health disparity. (Edwards et al. 2019; Ward et al. 2023) Though police are meant to function as arbiters of community safety, due to generations of systemic racism and other factors, police interactions within Black communities are more likely to experience adverse police encounters leading to associated poor mental health outcomes (Boyd R. 2018, Boyd R. 2016). Given these disparities, there is a need for healthcare professionals to consider their role in addressing this issue (Maroney and Zuckerman 2018).
Black youth are often provided instructions by caregivers on how to safely navigate police interactions through a discussion known as “The Talk” (Brunson and Weitzer 2011). Pediatricians could play a supportive role in these discussions as pediatricians already offer guidance on various safety-related topics. We sought to understand pediatrician perspectives on having discussions on safely navigating police encounters with Black patients and caregivers, including barriers and facilitators to having this discussion. We conducted focus groups with 19 attendings and 13 residents practicing at three primary care sites that predominately serve Black youth.
Our Findings
Three themes emerged from this work:
- Theme 1: Creating a comfortable environment for a discussion on navigating police interactions. Participants noted limited appointment times as a significant barrier, as discussing sensitive topics like this requires ample time. Despite challenges, facilitators such as seeking permission, strong patient relationships, and acknowledging racism's impact helped create a comfortable environment.
- Theme 2: Talking about racism is valuable but challenging, especially if racially non-concordant with the patient/family. Participants shared that discussing racism was difficult, particularly for white participants who could not personally relate to the patient's experience. Shared racial or ethnic identities made it easier for some, and current events like police brutality served as helpful entry points.
- Theme 3: Pediatricians desire support in having conversations about police brutality. Caregivers play a crucial role, often having already laid the groundwork for the conversation about police brutality at home and providing guidance on how to share information with children in a way that builds on that foundation. Physicians also expressed the need for operational support, such as embedded questions in questionnaires or a validated conversation script.
Actionable Insights
This research has implications for clinical practice, research, and medical education.
- Clinical practice A trusted relationship among pediatrician, caregiver and child is the foundation for having a meaningful conversation on safely navigating police encounters. Though as pediatricians we hope to provide the ideal roadmap, the guidance may be best led by the caregiver who more intimately knows the messages they seek to instill in their child. The goal of the pediatrician is to not have all the answers; the goal is to partner with the caregiver and youth to foster, within the youth, a sense of preparedness and safety in interactions with the police—to just get home safely.
- Research. While our work builds on the research from other disciplines (e.g., sociology, psychology) related to this topic, more research is needed to determine how to effectively integrate “The Talk” into pediatric practice. This will necessitate gathering the perspective of Black male adolescents and their families to determine the acceptability and feasibility of discussions with pediatricians. Pending the responses from those key informants, additional work is needed to validate specific methods to initiate this conversation (e.g., through pre-visit questionnaires, a conversation script, or additional modalities) and to ensure that we are appropriately informed to mitigate the risk of re-traumatizing or otherwise causing harm as we attempt to support our patients.
- Medical education. Educational leaders have the opportunity (and responsibility) to help prepare the next generation of pediatricians to navigate this anticipatory guidance more effectively. The cultural humility necessary to engage in this conversation is grounded in self-awareness; an understanding of history and its present-day ramifications; and a commitment to lifelong self-evaluation and improvement. While diversifying the physician workforce to help foster racial concordant patient-provider relationships will help in the rooms where those pediatricians are, ensuring that curricula develop the knowledge and skills to engage in these conversations regardless of the pediatrician race/ethnicity is a critical next step, consistent with the Accreditation Council for Graduate Medical Education and American Board of Pediatrics' focus on entrustable skills addressing racism and pediatric health inequities.
By addressing these challenges and leveraging existing strengths, we have an opportunity to support Black youth and their families in having discussions on police interactions.
JAMA Pediatrics published the findings as a Research Letter.
Additional Information
Drs. Dalembert and Eugene appeared on KPFA’s Law & Disorder podcast, hosted by Cat Brooks, where they discussed he role that doctors and pediatricians have in preparing patients and their families to be aware of this public health risk. Listen to the episode here.
Additional CHOP researchers include:
First author Jeffrey Eugene, MD, former General Pediatrics Fellow; Maria Christina Herrera MD, MSHP, Faculty Scholar in PolicyLab; Katherine Yun, MD, MHS, Health Equity Researcher at PolicyLab and Core Faculty Member in Clinical Futures; Nicole Jaffe, MD, Pediatrician; and Chandler Floyd is a former Clinical Research Assistant at PolicyLab.
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