‘Why Do We Treat Different Families Differently?’: Social Workers’ Perspectives on Bias and Ethical Issues in Pediatric Emergency Rooms

ABSTRACT

In pediatric emergency rooms (ERs), social workers must navigate diverse responsibilities including acting as advocates and liaisons between families and multidisciplinary treatment teams, providing compassionate support to families in crisis, and assessing for and reporting any suspicions of child abuse or neglect. These potentially contrasting roles can place social workers at the center of dealing with ethical dilemmas and advocating against ethical violations, such as bias and discrimination toward families. This qualitative study seeks to gain insight into ethical issues commonly encountered in pediatric ERs by exploring the perspectives of 23 social workers at Level 1 trauma centers in the United States. Thematic analysis was used to develop major themes and subthemes related to ethical violations, dilemmas, and best practices in pediatric ERs. Major themes emerged related to unfair treatment of families (with subthemes of bias, discrimination, and compassion fatigue), ethical dilemmas (with subthemes of cultural issues, safety and system issues), and promoting ethical practices (with subthemes of self-awareness, advocacy, and efforts to change the system). This study provides important insights into ethical issues in pediatric ERs as experienced by social workers and can inform efforts to improve the quality and equity of care for all families in pediatric ERs.

KEYWORDS:

• Pediatric emergency department
• ethical dilemma
• systemic racism
• implicit bias
• social work values

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Notes on contributors

Ray Eads

Ray Eads is an Assistant Professor in the Jane Addams College of Social Work at the University of Illinois Chicago. His research aims to improve outcomes for traumatized youth and families and expand the benefits of behavioral health treatments to vulnerable groups through person-centered and strengths-based practices and techniques.

Juan Lorenzo Benavides

Juan Lorenzo Benavides is a PhD student in Social Welfare at The Ohio State University, focusing on leveraging health services to promote resilience in minoritized youth who have experienced abuse and neglect. Lorenzo specializes in early childhood resilience, child welfare systems, and the impact of trauma on mental health.

Preston R. Osborn

Preston R. Osborn is a PhD candidate in the College of Social Work at The Ohio State University. His research interests center on understanding and advancing the development of culturally responsive and anti-oppressive practice capacities of health and human service professionals and systems.

Öznur Bayar

Öznur Bayar is a faculty member of the Department of Psychological Counseling and Guidance at Burdur Mehmet Akif Ersoy University, Türkiye. Her research interests include resilience after childhood trauma, childhood positive experiences, gender equality, and self-care of helping professionals.

Susan Yoon

Susan Yoon is an Associate Professor in the College of Social Work at The Ohio State University. Her research seeks to promote resilience and well-being in children who have experienced childhood trauma, including child maltreatment. She is particularly interested in identifying factors, mechanisms and pathways that support children to build resilience, following exposure to childhood adversity.