{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T16:03:05Z","timestamp":1793462585101,"version":"4.5.0"},"reference-count":83,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,1]]},"abstract":"<jats:p>Nia is a first-grade student with a history of trauma who was brought in by ambulance to the pediatric emergency department for \u201cout of control behavior\u201d at school. This is the first of multiple presentations to the emergency department for psychiatric evaluation, stabilization, and management throughout her elementary and middle school years. Several of the visits resulted in admission to the inpatient pediatric service, where she \u201cboarded\u201d while awaiting transfer to an inpatient psychiatric facility. At times, clinical teams used involuntary emergency medications and physical restraints, as well as hospital security presence at the bedside, to control Nia\u2019s behavior. Nia is Black and her story is a case study of how structural racism manifests for an individual child. Her story highlights the impact of adultification bias and the propensity to mislabel Black youth with diagnoses characterized by fixed patterns of negative behaviors, as opposed to recognizing normative reactions to trauma or other adverse childhood experiences\u2014in Nia\u2019s case, poverty, domestic violence, and Child Protective Services involvement. In telling Nia\u2019s story, we (1) define racism and discuss the interplay of structural, institutional, and interpersonal racism in the health care, education, and judicial systems; (2) highlight the impact of adultification bias on Black youth; (3) delineate racial disparities in behavioral health diagnosis and management, school discipline and exclusion, and health care\u2019s contributions to the school-to-prison pipeline; and finally (4) propose action steps to mitigate the impact of racism on pediatric mental health and health care.<\/jats:p>","DOI":"10.1542\/hpeds.2023-007133","type":"journal-article","created":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T08:17:27Z","timestamp":1681719447000},"page":"461-470","source":"Crossref","is-referenced-by-count":22,"title":["Structural Racism in Behavioral Health Presentation and Management"],"prefix":"10.1542","volume":"13","author":[{"given":"Tyler","family":"Rainer","sequence":"first","affiliation":[{"name":"aDivision of Emergency Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie K.","family":"Lim","sequence":"additional","affiliation":[{"name":"bDivision of Emergency Medicine, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Ilinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"He","sequence":"additional","affiliation":[{"name":"cDivision of General Pediatrics, Children\u2019s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Perdomo","sequence":"additional","affiliation":[{"name":"dDepartment of General Pediatrics, Nicklaus Children\u2019s Hospital, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Nash","sequence":"additional","affiliation":[{"name":"eDivision of Pediatric Critical Care and Hospital Medicine, New York-Presbyterian\/Columbia University Irving Medical Center, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline 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