Perceptions of racism in a children’s psychiatric inpatient unit: a qualitative study of entrenching and uprooting factors

Abstract Introduction It is well documented that race plays a role in health care access and outcomes. However, discussions about race in the workplace are often avoided. Aim/Question We sought to identify factors that may contribute to or deter from racism to inform interventions to sustain a psychologically supportive environment for patients and staff. Methods We conducted individual interviews about perceptions of race and racism using a purposive sample of twenty-two individuals in an acute child psychiatric inpatient service. We analyzed interviews systematically with thematic analysis guided by a constructivist grounded theory conceptual framework. Results We identified two countervailing processes: 1) Entrenching – factors that sustain or increase racism: Predisposing, Precipitating, and Perpetuating; and 2) Uprooting – factors that rectify or reduce racism: Preventing, Punctuating, and Prohibiting. We organized each of the elements in a “6P” model organized along a temporal sequence around sentinel racist events. For each of the six components we go on to include: Contributing Factors, Emotional Reactions, and Behavioral Responses as reported by participants. Implications for Practice Identifying factors that entrench or uproot racism can inform specific steps to improve the care of all children and families on an inpatient child psychiatry unit. These interventions could be applied to milieu-based inpatient settings serving patients of all ages.