Children with Disabilities Must Be More Than an Afterthought in School Reopening

The Individuals With Disabilities Education Act, adopted in 1975, mandates that all children have a right to appropriate and free public education services. Fourteen percent of public school enrollees (7.1 million children) receive special education services.1 

There Are Good Reasons Black People Don’t Trust Health Institutions, But I Still Got the COVID-19 Vaccine.

In the spirit of the remarks quoted above, I won’t try to convince fellow Black Americans that they should get the COVID-19 vaccine, only share my thought process before I got the first of my two shots last week. 

School Reopening During COVID-19 Pandemic: Considering Students with Disabilities

A novel coronavirus presented and began infecting humans, leading to a worldwide pandemic starting in 2019. The virus caused a severe respiratory syndrome in those most notably affected. As such, it was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses. SARS-CoV-2 is the virus that causes the coronavirus disease. 

African American Patient Disparities in Covid-19

This study highlights the higher morbidity and mortality due to COVID-19 faced by AAs and further supports known health inequities manifested across underrepresented communities in the United States. 

The Actual and Potential Impact of the Novel Coronavirus on Pediatric Rehabilitation: A Commentary and Review of Its Effects and Potential Disparate Influence on Black, Latinx and Native American Marginalized Populations in the United States.

Health disparities are also present at baseline in rehabilitation care. For example, there are notable racial and ethnic disparities in pain management resulting in Black and Latinx patients being less likely to get analgesia for acute pain than Whites [3]. Black and Latinx children requiring rehabilitation services following complex traumatic injuries were both less likely to be discharged to rehabilitation facilities and less likely to receive rehabilitation services after discharge from the acute care hospital [4]

Racial Disparities in Access and Outcomes from Rehabilitation Services.

The need for equitable racial and ethnic outcomes for patients under the rehabilitation umbrella is crucial to a physiatric practice.  Change requires approaches that move from micro to macro:  targeting individual behavior, institutional factors, and systemic challenges. Schematically, this is represented in Figure 1. 

Figure 1:  Resetting the Clock of Racial and Cultural Disparities

Microaggressions in Clinical Training and Practice.

It is important to distinguish between intent and impact: Intent is the understanding of what the actor meant by the behavior; the impact of the behavior is the effect the microaggression has on the recipient. The key is focusing on the impact we make on our trainees and others, not defending our intent. For example, as presented in the introduction to this journal section, microinvalidations are “communications that exclude, negate or nullify the psychological thoughts, feelings, or experiential reality of a person of color.” When we commit a microaggression, responses such as “I was just joking” invalidate the impact on the recipient and fail to move forward our training culture.

Slaying the Dragon: Empathy as a Weapon Against Racial Bias in the Workplace and Beyond.

Despite his many accomplishments, driving his car can be an intimidating experience for Maurice Sholas because of the color of his skin, he says.

“I am an MD-PhD from Harvard with a senior leadership position at a major organization, yet I’ve been stopped by police every time I’ve gone into the suburbs around Minneapolis,” Sholas says. “Not sometimes. Every single time.”

Facing Resistance.

While this patient’s case involves a number of ethical issues, this analysis addresses the problem of truth-telling and disclosure to a minor child over parental objection. Parents are traditionally granted authority to make decisions for their children because they are presumed to have the child’s best interests at heart and presumably are the most invested in good outcomes for their children. Parental authority is not absolute; the state can intervene if a parent is determined to not be acting in the child’s best interests. 

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Physical Abuse (Non-Accidental Trauma).

Inconsistencies or changes in the clinical history should raise suspicion of nonaccidental trauma. Look for incompatibility of the severity of the injury and the explanation of how it occurred. If the explanation is reluctantly provided, contradictory, or vague, there should be suspicion. Finally, if there have been several presentations of trauma, the usage of multiple emergency departments, or several failed routine appointments, the provider should be suspicious. A history of failure to thrive or factitious infirmities is also important to elicit in the history.

Oral Bisphosophonates to Treat Disuse Osteopenia in Children with Disabilities.

Children with congenital conditions who are nonambulatory have been observed to have pathologic fractures due to disuse osteopenia. Data support the use of intravenous bisphosphonates to treat this in children with disabilities, but there are no data to guide the use of oral bisphosphonate medication.