FACILITATING AWARENESS AND UNDERSTANDING OF DIVERSITY AND INCLUSION IN DCLINPSY TEACHING - PowerPoint Presentation

1. FACILITATING AWARENESS AND UNDERSTANDING OF DIVERSITY AND INCLUSION IN DCLINPSY TEACHING SESSIONSDr Fatoumata Jatta & Dr Jeremy Oliver14 December 2022

2. Session AimsTo create a safe space for discussing difference, diversity and cultural competencyTo consider how issues of difference, diversity and cultural competency might impact teaching of the clinical psychology training curriculum To find out more about barriers to communication, social graces, intersectionality and biasesTo reflect on what these topics mean for us personally and for our teachingTo identify commitments to action

3. Reflection pit-stop – what shows up for you when we start to talk about difference, diversity and cultural competence?

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5. Reflection pit-stopSettling into your chairBring awareness to the here and nowWhat shows up for you when we start to talk about difference, diversity and cultural competence?There is no right or wrong way of thinking or feeling.This is a personal reflection exercise - you don’t have to share your thoughts with anyone else.

6. Creating a safe spaceRespect for one another's views and opinionsTaking time to listen to others

7. Context setting – importance of difference, diversity and cultural competency for DClinPsy training at RHUL

8. Why does difference & diversity in CP matter?Department of Health and Social Care (2018); Patel et al., (2000); Williams et al., (2006); Eleftheriadou (1993); Kareem and Littlewood (1994); McIntosh (2017); Meldrum (1998); Bradbury and Kellough (2008); King et al., (2011); Workplace EDI (WRES), NHS England; Mental Health Bulletin, 2009; Bhui, 2002

9. Cultural competencies Knowledge of key evidence and an understanding of the importance of paying careful attention to issues of difference and diversity in relation to theory, clinical work and research.​The skills, knowledge and values to work effectively with clients from a diverse range of backgrounds, understanding and respecting the impact of difference and diversity upon their livesKnowledge of different cultures and awareness of the potential significance for practice of social and cultural difference, across a range of domains, including: ethnicity, culture, class, religion, gender, age, disability and sexual orientation. Being sensitive to own personal values, beliefs and biases and how these may influence perceptions of the client, the client’s problem, and the therapeutic relationship.Being culturally aware and sensitive to own cultural heritage and to valuing and respecting differences.Being aware of differences which exist between oneself and one’s clients in terms of race, gender, sexual orientation, disability and other socio-demographic characteristics.An understanding of the impact of power imbalances, prejudices and oppression on the experiences of those from minority backgrounds.An understanding of the intersection of oppression due to marginalised experiences and how this shapes an individual’s unique lived experience of prejudice.An understanding of the world view of culturally diverse clients and how this may shape expectations for the therapeutic relationship and acceptability and/or effectiveness of intervention.

10. Cultural competencies Knowledgeable about potential barriers that may impact on the accessibility and perceived usefulness of mental health services for diverse clients. To have knowledge of professional guidance and policies relevant to working with difference and diversity.An ability to conduct assessments, develop formulations and carry out interventions in a manner that is not prejudiced.Where social and cultural difference impacts on accessibility of interventions, an ability to make appropriate adjustments to the therapy, with the aim of maximising its potential benefit to the client. Ability to follow best practice when working with interpreters, to identify potential difficulties, and to review the work undertaken. Ability to develop formulations which incorporate the person’s cultural identity and values, and understanding of the way in which the intersections of the client’s, supervisor’s and trainee’s cultural values shape the development of the formulation. An ability to reflect on the ways in which one’s own and client's contexts may influence what goes on in clinical practice and the wider service and professional context, and vice versa. An ability to consider issues of difference (e.g. race, culture, religion, gender, sexuality, disability, age etc) as a routine part of discussion in supervision. ​A willingness to take an anti-racists stance in professional and client relationships and at an organisational level.

11. TOPIC 1: Barriers to communication

12. Barriers to communicationFear of getting it wrongImpression management – political correctnessFear of appearing racistDenial Defensiveness, anxiety, anger, helplessness, blameMinimising the topicGuilt - fear of realising our racism / racial prejudiceFeeling insulted, offended, accusedFeeling misunderstood, invalidatedFear of confronting White PrivilegeNot wanting to acknowledge pain suffered by minoritised groupsFear of taking responsibility to end inequality

13. Discussion: Impact on teaching sessionsHow might these barriers to communication affect DClinPsy teaching sessions?How could you take account of them/respond to them in DClinPsy teaching sessions?Do you ever experience these barriers to communication?

14. TOPIC 2: Social Graces & Intersectionality

15. Social Graces (Burnham,1992, 2012; Roper Hall,1998)

16. Social Graces (Burnham,1992, 2012; Roper Hall,1998)

17. IntersectionalityTheory to capture how different types of discrimination intersect to oppress people in multiple and simultaneous ways, contributing to social inequality and systemic injustice.(Crenshaw, 1989)“Knowing that a woman lives in a sexist society is not enough to understand her experience of that sexism: one must also know her race, sexuality, age and class to begin to understand her unique experience of discrimination” (Collin, 2000; from Butler, 2015)

18. Discussion: Impact on teaching sessionsHow might social graces and intersectionality affect DClinPsy teaching sessions?How could you take account of them/respond to them in DClinPsy teaching sessions?Have you had the opportunity to reflect on your own social graces and intersectionality?

19. TOPIC 3 – Bias and it’s effect on professional decision-making

20. Cultural Competence: A Systematic Review on the Role of Cultural Factors in Professionals’ Decisions about Child Maltreatment (Jatta, 2019)How do cultural factors influence professionals’ decisions about child maltreatment?

21. What is Culture?Leading social scientists Richerson and Boyd (2005) define culture as “information capable of affecting individuals’ behavior that they acquire from other members of their species through teaching, imitation, and other forms of social transmission.” Cultural knowledge therefore encompasses information and skills that an individual could not have developed in a lifetime. Culture is intricately linked to other identity markers such as race, ethnicity, language, and religion, with researchers still sometimes using the terms race, ethnicity, and culture interchangeably (Pfeffer, 1998).

22. The dilemma (an example), and why we need Cultural CompetencyChild maltreatment is one of the most powerful risk factors for concurrent and subsequent psychopathology, later health morbidity, and compromised development. Estimated that 40 million children experience abuse annually worldwide (WHO, 2014). Problems with the Definition of Child MaltreatmentDefinitions fail to meet research needs due to their lack of comparability, reliability, and universally understood delineations (Besharov, 1981). There remains very little guidance on how to interpret and implement statutory terms such as “significant harm” and “reasonable suspicion”, or what levels of concern should be reported (Levi & Crowell, 2011, p. 321).Negates social and cultural differences, making any cross-cultural comparisons problematic. Can you think of examples?

23. Common types of Bias

24. Explicit vs. Implicit Bias Explicit bias: bias that people knowingly-sometimes openly-embrace. Implicit bias: stereotypical associations so subtle that people who hold them might not even be aware of them.Researchers have found that black defendants fare worse in court than do their white counterparts. In a study of bail-setting in Connecticut, for example, Ian Ayres and Joel Waldfogel found that judges set bail at amounts that were 25 % higher for black defendants than for similarly situated white defendants. In an analysis of judicial decision-making under the Sentencing Reform Act of 1984, David Mustard found that federal judges imposed sentences on black Americans that were 12 % longer than those imposed on comparable white defendants. Research on capital punishment shows that "killers of White victims are more likely to be sentenced to death than are killers of Black victims" and that "Black defendants are more likely than White defendants" to receive the death penalty."

25. The Privilege Wheel

26. Summary of included studies in the systematic reviewSixteen studies were identified between the years 1983 and 2018.Majority of studies (81.25%) were concerned with race/ethnicity variables of the case, professional, or both. Only one study was concerned with country of residence and two investigated faith-related factors.Just over 62% of the review studies found evidence of cultural bias concerning child maltreatment decisions among professionals of different disciplines. However, the extent and nature of this is unclear.

27. Case and perpetrator variablesOf the 13 vignette studies, 8 (62%) found that race/ethnicity influences the decision-making of professionals, while 5 did not. Some vignette studies found that certain professionals (psychologists, social workers, and police) judged vignettes with a Black family as less severe and less likely to be reported than identical vignettes with a White family. However, some studies also found a variety of professionals more likely to judge cases of physical and sexual abuse involving Black families, as abuse, as more serious, and as requiring a report. Why?

28. Professional variablesCroatian social workers were found to be more likely than Swedish social workers to judge identical cases of different types of maltreatment as abuse and consider compulsory removal of the child, suggesting that cultural/social welfare system differences between the two countries may lead to distinct clinical outcomes (Pećnik and Brunnberg,2005).Compared to Asian and White preservice teachers, African-American teachers have been found to be more accepting of corporal punishment, and to have experienced it more often in their own childhoods (Kesner et al., 2016; Kesner & Stenhouse, 2018). But did not differ from the other racial groups in terms of their ratings of abusiveness, and how they understand child maltreatment and their role as mandated reporters.However, in a study investigating their actual reporting behaviour, it was found that none of the Black teachers had reported abuse, compared to 31.51% of White and 27.58% of Hispanic teachers, possibly indicating a reluctance to report abuse as a result of cultural norms (Kenny, 2001, p. 88).

29. Religion/faith-related variables Evidence of a wide range of practices, across several racial and ethnic groups, including medical neglect, excessive corporal punishment, ridding-evil practices, and also FGM and honour based violence. Bottoms et al., (1995) collected data on 1652 cases of child abuse. Found that 94% of abuse was perpetrated by religious professionals, mostly Catholic, fundamentalist, or Protestant. 48% of cases involved ridding-evil, and 23% of neglect cases involved sexual abuse. Social services more likely to investigate ridding-evil or medical neglect cases.Cases of medical neglect unlikely to be prosecuted.Oakley et al., (2017) is a UK study that found that:only 33% of professionals were confident they would be able to identify child abuse linked to faith or belief (CALFB).74% had received no specific training on CALFB.

30. Decision-making TheoriesDecision-Making Ecology (DME) model (Baumann et al., 1997)

31. Decision-making TheoriesJudgments and Decisions Processes in Context (JUDPIC) (Benbenishty & Arad-Davidson, 2012)

32. Reflection pit-stop – how has bias showed up for you while teaching on the course?We all have bias. How has bias showed up for you as a lecturer on the course?There is no right or wrong way of thinking or feeling.This is a personal reflection exercise - you don’t have to share your thoughts with anyone else.

33. Discussion: Impact on teaching sessionsHow might bias affect DClinPsy teaching sessions?How could you take account of/respond to bias in DClinPsy teaching sessions?Have you had the opportunity to reflect on your own biases?

34. Final reflections/Q&A

35. Commitment to actionWhat actions can/will you take in response to today? (E.g., increase understanding about X, find way to explain my approach to situation X based on my previous life experiences, notice when I do certain things in clinical practice and try to understand why etc.)

36. FeedbackPlease complete the online feedback form – this would be a great help in amending/updating the session for the future

37. References & Further ReadingAdetimole, F., Afuape, T., & Vara, R. (2005) The impact of racism on the experience of training on a clinical psychology course.  Clinical Psychology Forum, 48 (May), 11-15Akala (2018) Natives: Race and Class in the Ruins of Empire . Two Roads.Beck, A. (2016) Talking to Black and Ethnic Minority service users about their experience of racism, CBT Today, September, 14-16.Burnham, J. (1992). Approach – method – technique: making distinctions and creating connections. Human Systems, 3, 3–27.Burnham, J. (2012) Developments in Social GRRRAAACCEEESSS: visible – invisible and voiced – unvoiced. In I.-B. Krause, (ed.) Culture and Reflexivity in Systemic Psychotherapy: Mutual Perspectives (pp. 139–160). London: Karnac.Butler, C. (2015). Intersectionality in family therapy training: Inviting students to embrace the complexities of lived experience. Journal of Family Therapy, 37(4), 583-589.Constantine, MD & Sue, DW (2006) Addressing Racism. WileyCrenshaw, K. (1989) Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory, and antiracist politics. University of Chicago Legal Forum, 140, 139–167.Decolonising the Academy #RMF http://www.ascleiden.nl/content/decolonizing-academy-informal-conference-reportGrice, T., Alcock, K., and Scior, K. (2018). Mental health disclosure among clinical psychologists in training: Perfectionism and pragmatism. Clinical Psychology and Psychotherapy, 25(5), 721-729. doi: 10.1002/cpp.2192Holdstock, L.  (2000) Re-Examining Psychology: Critical Perspectives and African Insights. Routledge.Mackintosh, P. (1990). Unpacking the Invisible Knapsack. http://mmcisaac.faculty.asu.edu/emc598ge/Unpacking.htmlNwoyo, A. (2015) African psychology and the Africentric paradigm to clinical diagnosis and treatment. South African Journal of Psychology, 45(3), 305-317.Patel, N., et al., (2000) Clinical Psychology, Race and Culture. BPS.Sue, D. W., and Sue, D., (2016). Counseling the Culturally Diverse (7th edition).Sue, D. W., (2016). Race Talk and the Conspiracy of Silence: Understanding and Facilitating Difficult Dialogues on Race. Sue, D. W. (2010). Microaggressions in Daily Life: Race, Gender and Sexual Orientation.Richards, G. (2012) ‘Race’, Racism and Psychology. Routledge.Roper-Hall, A. (1998) Working systemically with older people and their families who have ‘come to grief’. In P. Sutcliffe, G. Tufnell and U. Cornish (eds) Working with the Dying and Bereaved: Systemic Approaches to Therapeutic Work (pp.177–206). London: Macmillan.Shah, S., Wood, N. & Nolte, L. (2012 )The experiences of being a trainee clinical psychologist from a black and minority ethnic group: a qualitative study. Clinical Psychology Forum. April, p. 32-35Doane, A.W. & Bonilla-Silva, E. (2003) White Out: The Continuing Significance of Racism. Routledge.

38. DiAngelo, R. (2018) White Fragility. Boston: Beacon Press.Eddo-Lodge, R. (2017) Why I'm No Longer Talking to White People About Race. Bloomsbury.Fernando, S. (2017) Institutional Racism in Psychiatry and Clinical Psychology. Palgrave Macmillan.Nolte, L. (2007) White is a colour too. Journal of Family Therapy, 29(4), 378-388.Patel, N. (2018) Fifty Ways to Leave Your…Racism. Journal of Critical Psychology, Counselling and Psychotherapy, 18 (2), 61-79.Speller, K (2015) Why It’s Not Racist To Talk About White Privilege. MTV News. http://www.mtv.com/news/2196003/heres-why-its-not-racist-to-talk-about-white-privilegeWa Thiong’o, N. (1986) Decolonising the Mind. (James Currey Edition, 2011).Wood, N. & Patel, N. (2017).On Addressing Whiteness During Clinical Psychology Training. SAJP:  https://journals.sagepub.com/doi/abs/10.1177/0081246317722099?journalCode=sapc#articleShareContaineMerced K, Imel ZE, Baldwin SA, Fischer H, Yoon T, Stewart C, Simon G, Ahmedani B, Beck A, Daida Y, Hubley S, Rossom R, Waitzfelder B, Zeber JE, Coleman KJ. Provider contributions to disparities in mental health care. Psychiatr Serv. 2020 Apr 28: doi: 10.1176/appi.ps.201800500. [Epub ahead of print]Green JG, McLaughlin KA, Fillbrunn M. Barriers to Mental Health Service Use and Predictors of Treatment Drop Out: Racial/Ethnic Variation in a Population-Based Study. Adm Policy Ment Health. 2020 Feb 19. doi: 10.1007/s10488-020-01021-6. [Epub ahead of print]Biener AI, Zuvekas SH. Fukuda M, Jackson JS, Kessler RC, Sadikova E, Sampson NA, Vilsaint C, Williams DR, Cruz-Gonzalez M, Alegría M. Do Racial and Ethnic Disparities in Mental Health Treatment Vary With Underlying Mental Health? Med Care Res Rev. 2020 Feb 7: doi: 10.1177/1077558720903589. [Epub ahead of print]

39. Resources: Films“Homoworld”https://www.youtube.com/watch?v=HJXw8PthD0M“Talk” (Disability Rights Commission) https://www.youtube.com/watch?v=Oh-7t-zVWQ0&feature=youtu.beThe privilege race: https://www.youtube.com/watch?v=C17LiVmGyaU