5.1 Implicit (and Explicit) Bias

A bias is a personal and sometimes unreasoned judgment against a person, place or thing. Implicit biases are a biases or prejudices that are present but not consciously held or recognized so we are often unaware of them.

An explicit bias is a personal and unreasoned judgement that we have about a person, place or thing on a conscious level. Both implicit and explicit biases can show up as prejudice, discrimination or oppression on individuals, groups or within a system.

Decades of research have demonstrated that discrimination, driven by implicit bias, impacts healthcare access, trust in clinicians, care quality, and patient outcomes (Dirks et al, 2022). Implicit bias is widespread, even among individuals who explicitly reject prejudice (Payne et al., 2019). The troubling thing for healthcare professionals is the possibility that biased judgment, and biased behavior can affect patient care (FitzGerald et al., 2019).

5.2 Decision Making and Diagnostic Bias

The use of racial terms to describe epidemiologic data perpetuates the belief that race itself puts patients at risk for disease, and this belief is the basis for race-based diagnostic bias. Rather than presenting race as correlated with social factors that shape disease or acknowledging race as an imperfect proxy for ancestry or family history that may predispose one to disease, the educators we observed portrayed race itself as an essential—biologic—causal mechanism.

Amutah, et al., 2021
New England Journal of Medicine

Healthcare providers are vulnerable to a range of biases when making decisions, particularly diagnostic and treatment decisions. Many biases have been described in the healthcare literature, and many of these have been shown to influence decisions (Featherston et al., 2020).

Patient-provider interactions, treatment decisions, patient adherence to recommendations, and patient health outcomes can be influenced by bias. This can lead to an unintentional form of discrimination that affects decision-making structurally and systematically and is hard to identify and uncover (Nápoles et al., 2022).

Studies have shown that implicit racial bias profoundly influences clinical decision-making. It affects nonverbal behaviors such as eye contact and posture and has been shown to influence the quality of a provider’s interpersonal communications and, in turn, the patient’s trust and perception of the provider (van Ryn et al., 2015).

5.3 The Impacts of Bias in Child Welfare

Significant disparities exist throughout the child welfare system. Research has shown that mandated reporters' decisions to report a family to the Statewide Central Register is often influenced by biases and personal beliefs. An implicit bias may even sway you to make a report against one parent or caregiver and not another even when the objective facts and information are the same.

Research also shows that these biases contribute to a disproportionate number of reports being called into the SCR on specific individuals or groups—including communities of color and Black communities in particular—more than others. This leads to a disproportionate level of CPS involvement in certain communities that can have long-lasting and devastating impacts on families and communities (NYSOCFS, 2024).

Once reported, cases involving Black children are more likely than others to:

• be accepted for investigation,
• be confirmed,
• be brought to court, and
• result in removal of the children from their families. (Palusci and Botash, 2021).

Furthermore, it is likely that family separations in these cases will be longer, and the cases will take longer to be closed. Multiple points in this process are subject to bias, but the process begins with reporting (Palusci and Botash, 2021).

When assessing information received about a child and their family, instead of making assumptions or jumping to conclusions that a child is being maltreated or abused, mandated reporters must evaluate potential biases that affect their decision to report (NYSOCFS, 2024).

For example, would your decision to call the Statewide Central Register with a report of suspected child maltreatment or abuse change if any of the following were different?

• race or ethnicity
• primary spoken language
• age
• neighborhood where they reside
• occupation
• presence of a disability
• socioeconomic status of the family
• gender identity or expression
• sexual orientation or sexual expression
• culture and/or immigration status
• religion (NYSOCFS, 2024)

Similarly, when considering not to report, check if these thoughts are coming up: “they are such a good family,” “I have known them since they were children,” “my patients would never do that,” or similar emotional reasoning (Palusci and Botash, 2021).

Keep in mind that you can support a family without having to a report them by approaching the situation with empathy, compassion, care, and curiosity. Also consider if the needs of the family can be met through other means outside of the CPS system.