P3.157: Foundations of an Anti-Racist Pediatric Clinical Practice: Findings Using a Modified Delphi Approach

Background: Racial and ethnic health disparities among youth are driven by systemic racism, or policies and practices embedded in society that produce unfair treatment and outcomes for minoritized people. The association between systemic racism and adverse emotional, mental, and physical health has been well documented for youth. Given that pediatric clinics see over 85% of youth aged 0-17, these environments can play a crucial role in promoting ANTI-racism. According to the National Academies of Sciences Engineering and Medicine, anti-racism is an active and intentional set of actions that dismantle and disrupt racism and can include policies, practices, cultures, and systems. Although pediatric clinics can play an important role in helping to reduce systemic racism’s contribution to health inequities, to our knowledge, there is no clear guidance on how to create an anti-racist pediatric clinic. Therefore, the objective of this study, was to develop expert consensus recommendations on creating an anti-racist pediatric clinic.

Methods: We conducted a modified Delphi panel study between August 2021 and February 2022 asking content area experts about components of an anti-racist pediatric practice, including the look and feel of this setting. Three iterative questionnaires were completed, analyzed, summarized, and presented back to the experts for review and feedback on areas of consensus and disagreement. We used qualitative methodology to analyze the first survey, that was all open-ended 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) included pediatricians, educators, psychologists, teachers, youth, and parents (see Table 1). Themes that met consensus for the components an anti-racist pediatric practice should have were categorized into the commitment to access (e.g. having flexible cancellation policies), commitment to the community (e.g. gathering input from community liaisons), services/resources and funding (e.g. having multilingual interpreter services), and institutional buy-in (e.g. ensuring the institution has a zero-tolerance for racism). Additionally, themes were extracted describing the look (e.g. accessible to all abilities), and feel (e.g. inclusive and welcoming) an antiracist pediatric practice should have. Experts also provided recommendations on how and what to evaluate or measure within an anti-racist pediatric clinic (see Table 2).

Conclusion: To our knowledge, this study provides the first expert consensus recommendations for pediatric clinics to create an anti-racist environment. Pediatric clinical leaders can use these consensus themes as a foundation to build an anti-racist clinical practice.