Mandated Reporting, Medical Practices and Black Familial Health Disparities- a Qualitative Study

BAGROUND Health disparities within Black communities and poor medical adherence has remained a growing concern within health disparities research (Rao et al, 2020; Lee & Salloum, 2016; Kalichman et al, 2016). Factors associated with lower medical adherence like educational levels (Braverman & Dedier 2009), social-supports (Schoenthaler et al, 2016), self-efficacy (Lewis et al, 2012) and patients’ mistrust with medical providers (Nguyen et al, 2009) remain well documented across studies examining patients’ experiences with varying prevalent health disparities plaguing the Black community. Meanwhile data across numerous jurisdictions report Black parents receive disproportionately high child protective services reports from health care providers (Berkman et al, 2022; Roberts et al, 2024). This same research attributes such overreporting practices to racial/ethnic bias amongst medical professionals (Berkman et al, 2022; Roberts et al, 2024; Detlaff & Boyd, 2020). However, no studies to date have explored the experience of Black parents’ medical decisions surrounding adherence for their children in light of mandated reporting practices by health professionals. As medical adherence remains a highly researched domain in health research (Hall & Health, 2021), this novel study seeks to introduce innovative structural harm theoretical frameworks for exploring mandated reporting practices as potentially relevant factors in influencing Black familial health. This exploratory qualitative study was guided by the following questions: How do Black parents perceive child welfare related mandated reported practices? ; and How does mandated reported practices influence the medical adherence practices of Black parents and their general decision making around engaging the medical field as it pertains to their children?

METHOD This qualitative study was conducted using the techniques of grounded theory in analyses in order to develop the themes from the interviews. Snowball sampling was used to reach saturation. The sample consisted of 21 self-identifying Black parents/caregivers who engaged in consistent wellness checks with their children. Five men and 16 women were interviewed. One on one interviews were digitally recorded, transcribed, and imported into Qualitative software for analysis. An inductive exploratory approach was used to examine the research questions guiding the study.

RESULTS Four relevant themes elicited from the study data will be presented in this proposal from the lens of the Black parental or caregiver experience: (1) Extreme communal fear of systemic surveillance (2) Mandated reporting can impedes pediatric medial utilization (3) Anti-Black bias amongst medical professionals (4) Prevalence of Black paternal anxiety in pediatric engagement

CONCLUSION This study serves as a strong foundation in understanding how structural violence should serve as a significant social determinant of health for Black communities as the study results displayed that Black familial medical adherence and engagement was influenced by anxieties surrounding engagement of the medical system. As Black families continue to remain vulnerable to institutional control and fear of systemic violence this study highlights the need for anti-oppressive policy reform, anti-racist practices and further research exploring the upstream causes of health inequities, such as the systems, structures and laws.