Dissertation Presentation: Jessica Marie Coleman

PhD candidate Jessica Marie Coleman will present her dissertation "What Grace They're Willing to Give: Individual and Institutional Influences on Medical Neglect Reporting in Urban Hospital Settings."

Advisor: Joan Blakey, PhD

Committee: Ross VeLure Roholt, PhD, Jeff Waid, PhD, and Samuel Myers Jr, PhD (School of Public Affairs)

When: Tuesday, August 11, 2026 from 1:00 to 2:00 pm

Where: Room 5 Peters Hall or Zoom

Dissertation abstract: Racially and socioeconomically marginalized families are disproportionately represented in child welfare reporting, yet limited research has examined how healthcare professionals identify and report suspected medical neglect. This qualitative study examined two questions: (1) How do professionals’ conceptualizations of medical neglect and the individual and institutional contexts in which they work influence their determinations and reporting practices? (2) How do race, culture, and socioeconomic status shape professionals’ perceptions of medical neglect and influence their reporting practices?

The study draws on in-depth interviews with 21 mandated reporters working in urban hospitals and clinics in the Twin Cities, including social workers (n = 11), physicians (n = 5), nurses (n = 4), and one legal professional. Guided by Becker’s taste-based discrimination theory and Critical Race Theory, the study used reflexive thematic analysis to examine how clinical judgment, institutional practices, professional norms, racialized beliefs, and families’ social and cultural contexts shape determinations of medical neglect and reporting decisions.

Findings revealed three interconnected patterns. First, participants relied on an informal risk continuum: emerging, elevated, and significant risk—to assess the severity of potential harm and decide whether to provide additional support, increase monitoring, or file a child protection report. Second, reporting decisions were influenced by preference-based judgments about treatment choices, disagreements between families and providers, health literacy and language, and culturally specific assumptions about parental fitness. Third, participants described racialized and socioeconomic pathways through which White, middle-class parenting norms shaped perceptions of credibility, responsibility, risk, and deservingness. Racially marginalized and low-income families were often subjected to greater scrutiny, while more privileged families were more likely to receive flexibility, credibility, and the benefit of the doubt. Providers with marginalized identities or relevant lived experiences also offered counterstories that challenged deficit-based interpretations of families’ behavior.

The findings demonstrate that medical neglect reporting is shaped not only by clinical risk but also by subjective judgments and institutionalized racial and socioeconomic inequities that influence healthcare providers' actions; implicit and explicit biases based on white-normative standards that can result in misjudgments; and race and socioeconomic status, often used as a precursor for who is believed or not. Participants described heightened scrutiny of racially marginalized and low-income families, alongside concerns that implicit and explicit biases and racism can operate invisibly to further marginalize individuals who don’t fit the White-normative standards and further marginalize families who hold marginalized identities.

The study highlights the need for clearer reporting criteria, standardized training on medical neglect, multidisciplinary consultation, culturally and linguistically responsive practices, policy reforms that minimize bias in mandated reporting, and institutional safeguards to reduce bias in mandated reporting.