目标:黑人出生的父母及其新生儿不成比例地经历了卫生保健专业人员(HCPs)对新生儿进行的产前物质暴露的药物测试,这有助于儿童保护服务(CPS)报告,家庭分离,和终止亲权。这项定性研究旨在通过探索知识来询问主导权力结构,态度,以及HCPs和CPS专业人员关于结构性种族主义对新生儿药物测试实践不平等的影响的经验。
方法:我们对30名医生进行了半结构化访谈,助产士,护士,社会工作者,和CPS专业人员在解释性框架的指导下,并进行归纳,反身性主题分析。
结果:我们确定了3个主要主题:(1)医院结构以外的种族主义程度导致黑人新生儿的药物检测率提高;(2)不一致的医院政策导致州法律和下游CPS报告的种族化应用;(3)医疗保健专业人员对CPS报告对黑人家庭的益处和不成比例的危害的了解影响了他们的决策。
结论:卫生保健专业人员认识到结构性种族主义是不成比例的新生儿药物测试的驱动因素。HCPs缺乏知识和技能限制是拆除权力结构的障碍,从而阻碍了系统级的变革。制度变革应将重点从生物学测试和报告转移到通过以家庭为中心的物质使用治疗来支持父母和孩子的共同需求。需要进行州和联邦政策变更,以确保黑人家庭的健康公平,并在不担心虐待和忽视儿童的情况下向CPS报告产前物质暴露。
OBJECTIVE: Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices.
METHODS: We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis.
RESULTS: We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making.
CONCLUSIONS: Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.