Clinical Considerations in Working with Children and Adolescents of Color: Past, Present and Future

Background Objectives: Systemic racism and health inequality for Children and Adolescents of Color (CAoC) and their families need to be acknowledged and addressed in the provision of mental health treatment by child and adolescent psychiatrists. The lack of parity for behavioral health drives the lack of integration of “mental” health with overall health and the lack of funding, policy, planning, and practices to support the social and emotional health of children and their families. Additionally, the unequal treatment faced by Black, Indigenous, and People of Color (BIPOC) children and their families further impacts their overall health and mental health outcomes. Implicit biases, conscious and unconscious, influence clinical judgments, lead to errors in diagnostic and treatment decisions and impair child and adolescent psychiatrists’ ability to fully partner with families to treat, advocate for, and improve the clinical and life trajectories of this diverse group of young people and families that child and adolescent psychiatrists are called to serve. Methods: Using a case vignette, this paper discusses historical examples showing how child and adolescent psychiatrists’ implicit bias may manifest when working with CAoC. Medical training and clinical practice have paid scant attention to the broader impacts of systemic racism and inequities in healthcare until recent years. Discussion: This article provides clinical recommendations for clinicians to navigate these factors through trauma-centered and patient-centered care. Viewing through the lens of intergenerational racial trauma and acknowledging one’s own bias, clinicians can better help and support CAoC as they strive toward a brighter future.