O3222: How to Talk to Children and Adolescents About Race and Racism in Pediatric Clinical Settings: Findings Using a Modified Delphi Approach

Background: Racism is a major public health issue that is at the root of health disparities impacting minoritized children and adolescents. Despite this, there has been little guidance on how pediatricians should approach conversations about racism in the health care setting. The association between racism and adverse emotional, mental, and physical health has been well documented among children and adolescents. The negative impact of racism on health can be mitigated by creating positive racial identities through conversations about race and racism. Therefore, pediatricians are well-positioned to support families in recognizing and intervening on the health impact of racism by having conversations about race and racism in the health care setting. The objective of this study, was to develop expert consensus recommendations for conversations about race and racism with children and families in the health care setting.

Methods: We conducted a modified Delphi panel study between August 2021 and February 2022. Three iterative questionnaires were completed by content area experts and were analyzed, summarized and presented back for review and feedback on areas of consensus and disagreement. We used constant comparative methodology to analyze the first survey and quantitative measures of agreement for the expert panel were calculated for the second and third surveys using interquartile ranges, Kendall’s W, and percent agreement.

Results: The final panel (n=29) was multi-disciplinary, including pediatricians, educators, psychologists, youth, parents and teachers. Themes that met expert consensus were categorized as occurring before, during, or after clinical conversations. Before entering conversations about race and racism, pediatricians should have appropriate knowledge about the history of racism, awareness of their own biases and privilege, and should be able to seek out relevant information and resources for anti-racism and anti-bias education. Before opening conversations with patients, pediatricians should also consider each patient’s background, including their culture, trauma history and developmental stage, triage the patient’s medical needs, and build trust and rapport. During conversations about racism, pediatricians should actively listen and display adaptive learning. After conversations, patients and families may begin to recognize the clinical setting as an environment that bolsters cultural safety and be more willing to share additional experiences with racism. Important themes that met consensus also addressed impediments to having these conversations in a clinical setting, such as a lack of time and resources, and providers’ ability and willingness to have the conversations.

Conclusion: To our knowledge, this study provides the first expert consensus recommendations for pediatricians to have conversations with children and families in clinical settings about race and racism. Pediatricians can use these consensus themes as actionable guidance to support effective communication around racism and health.