How Racism Impacts Those We Serve and How We Serve

DOTTIE LEBRON, MPA JAYSON JONES, LMSW KARA DEAN-ASSAEL, LMSW YVETTE KELLY, LMHC 4/29/2016

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Overview ‣Expanding our Understanding of Racism ‣How Racism Impacts those We Serve in the

Behavioral Health Profession ‣What Can We Do - Applying a Racial Equity

Lens in a Behavioral Health context

Race – a Social and Political Construct

‣ There is no biological basis for race categories.

‣ All human beings share the same set of genes.

‣ A person’s race can change from one society to another. It’s one of the ways we understand race as a social concept.

‣ “Race is not a biological

category that is politically charged. It is a political category that has been disguised as a biological one…” Ex. US. Census

Human Genome Project ‣ Genetic science has revolutionized biology and

medicine, and rewritten our understanding of human history. Under the Human Genome project that began as an international collaborative scientific initiative in 1990, scientists decoded the human DNA sequence. They announced at the White House in 2000 that “race has no genetic or scientific basis”.

‣ Human beings are 99.9 percent identical genetically

‣ Of the 0.1 percent variation that does exist among humans, 85% of this slight variation occurs among geographically distinct groups

Race-based Human Hierarchy Early Racism

In the late 18th century and early 19th century, a number of anthropological thinkers in North America and Europe began to construct what became the “pseudo-science” known as “racism”. These early philosophers began stratifying humans creating a human race-based hierarchy that ascribed geographical and particular physical characteristics as inferior or superior.

Carl Linnaeus Johann Blumenbach

Racism as a Historical Ideology ‣ Racism helped structure American society and its

institutions.

‣ Despite the recent civil rights movement which led to legal protections for Blacks in American society, the influence of racism continues to be experienced within our daily lives by everyone.

‣ One of the most obvious human consequences of the creation of this race-based human hierarchy (aka. White supremacy) are racial disparities, for example: health disparities, racial achievement gap, mass incarceration of people of color.

What Do We Mean by Racism? ‣ More and more it has become important to build

awareness on what we mean as researchers when we talk about racism.

‣ As researchers when we are speak about racism, we usually are not referring to its most popular use in mainstream media.

‣ For example most of us are familiar with racism as being race based prejudice that is directed at an individual or group by a person that harbors race prejudice.

Common Examples of Individual Racism and Racial Microaggressions ‣ Being excluded or passed

over for employment based on race

‣ Being followed in stores (“shopping while Black”)

‣ Cashiers asking for extra identification

‣ Insensitive remarks by coworkers and friends

‣ Profiling by law enforcement (“driving while Black”)

‣ Being feared and avoided ‣ Racial slurs ‣ Threats

Racism ‣ A system of oppression that is based on racial

categories and domination that designate one group as superior and the other(s) as inferior, and then uses these perceived differences to justify inequity, exclusion, or domination.

Structural Racism (i.e. Institutional Racism)

The social, economic, educational, and political forces or policies that operate to foster discriminatory outcomes or give preference to members of one group over others, derived from race as a concept.

Polling Question! ‣Does Racism Exist in Your Organization? A. Yes B. No C. I don’t know

Why is Thinking About Racism Important?

‣ Racism is stressful

‣ Racism is a leading and contributing factor to many health disparities within the United States

‣ Psychological, physiological, and socio-economic toll on people of color

‣ Stress from racism includes discriminatory harassment, racial harassment and racial discrimination among people of color

(Sawyer, Major, Casad, Townsend, & Mendes, 2012; Williams & Mohammed, 2009; Carter, 2007)

Racism is a Chronic Life Stressor

• Experiencing racism is linked to – Increased rates of depression – Binge eating – Binge drinking – Weight gain – Obesity – Hypertension – Heart disease

(Harrington et al., 2010; Vines, Baird, Stevens, Hertz-Picciotto, Light, & McNeilly, 2007; Cozier, Wise, Palmer, & Rosenberg, 2009; Blume et al., 2012; Banks & Kohn-Wood, 2007; Torres et al., 2010; Hicken, Hedwig Lee, Morenoff, House & Williams, 2014)

Racism is a Chronic Life Stressor

‣ People of color are disproportionally affected by behavioral health challenges

‣ Lifetime prevalence of PTSD is higher amongst people of color

‣ African American and non-white Latino persons report higher rates of severe and moderate depressive symptoms

(Roberts, Gilman, Breslau, Breslau, & Koenen, 2011; Loo, C.M., 2015; NCHS, 2014)

Why is Thinking About Racism Important as a White Person?

Unfaircampaign.org

Why is Thinking About Racism Important as a White Person? ‣Racism affects us as white people. ‣White people can be allies in this fight for

equality and justice. ‣White people can help to stop the

‘WhiteWashing’ by standing up against racism.

‣White people can also honor their own identities and cultural backgrounds to open space for others’.

Let’s Chat: What is White Privilege?

White Privilege

The White Privilege 1. I can if I wish arrange to be in the company of people of my race most of the time.

2. If I should need to move, I can be pretty sure of renting or purchasing housing in an area, which I can afford and in which I would want to live.

3. I can be pretty sure that my neighbors in such a location will be neutral or pleasant to me.

4. I can go shopping alone most of the time, pretty well assured that I will not be followed or harassed.

5. I can turn on the television or open to the front page of the paper and see people of my race widely represented.

6. When I am told about our national heritage or about “civilization,” I am shown that people of my color made it what it is.

7. I can be sure that my children will be given curricular materials that testify to the existence of their race.

8. I can go into a music shop and count on finding the music of my race represented, into a supermarket and find the staple foods which fit with my cultural traditions, into a hairdresser’s shop and find someone who can cut my hair.

9. Whether I use checks, credit cards or cash, I can count on my skin color not to work against the appearance of my financial reliability.

10. I can do well in a challenging situation without being called a credit to my race.

11. I am never asked to speak for all the people of my racial group.

12. I can remain oblivious of the language and customs of persons of color who constitute the world’s majority without feeling in my culture any penalty for such oblivion.

13. I can criticize our government and talk about how much I fear its policies and behavior without being seen as a cultural outsider.

14. I can be pretty sure that if I ask to talk to “the person in charge,” I will be facing a person of my race.

15. If a traffic cop pulls me over or if the IRS audits my tax return, I can be sure I haven’t been singled out because of my race.

16. I can easily buy posters, post-cards, picture books, greeting cards, dolls, toys, and children’s magazines featuring people of my race.

17. I can choose blemish cover or bandages in “flesh” color and have them more or less match my skin

18. I can be sure that if I need legal or medical help my race will not work against me.

‣ Disparities in quality of care are unfortunately common:

• Blacks received worse care than Whites for 41% of quality measures. • Hispanics received worse care than non-Hispanic Whites for 39% of measures.

‣ Disparities in access are also common, especially among Hispanics and poor people:

• Blacks had worse access to care than Whites for 32% of access measures. • Asians had worse access to care than Whites for 17% of access measures. • Hispanics had worse access to care than non-Hispanic Whites for 63% of access

measures. • Poor people had worse access to care than high-income people for 89% of access

measures.

The White Privilege

The White Privilege Education

‣ Whites are 78% more likely to be accepted to the same university as equally qualified people of color. Emphasis on “equally qualified.”

‣ Once admitted, 71% of white students receive degrees, compared to only 29% of people of color.

‣ When they do graduate, black college graduates have significantly more debt than whites. Employment

‣ And even when you factor all of the above in, the “get an education, get a job” argument still has massive problems. Because even when they manage to beat the stacked deck and graduate high school without a criminal record, they still face huge discrimination.

‣ A black college student has the same chances of getting a job as a white high school dropout. ‣ Meanwhile, a white male with a criminal record is 5% more likely to get a job than an equally

qualified person of color with a clean record.

Wealth ‣ While a college-educated white American has an average net worth of $75,000, a college-

educated black American has an average net worth of less than $17,500. ‣ The black-white wealth gap is greater in the United States today than it was in South Africa in

1970, at the height of apartheid.

http://www.jbwtucker.com/ultimate-white-privilege-statistics/

Race within the Workforce ‣ About 85% of licensed social workers are White non-Hispanics, but only 68% of the general

population is White non-Hispanic. ‣ Approximately 7% of social workers surveyed were Black/African American ; 4% were

Hispanic/Latino.

These demographic discrepancies between licensed social workers and the population as a whole indicate that social workers in

general are increasingly working with client populations from varied minority backgrounds.

‣ Approximately 85% of licensed social workers in the study reported working with Black/African American clients

‣ 77% reported working with Hispanic clients ‣ Approximately 49% worked with Asian/Pacific Islander clients, while 39% reported working

with Native American/ Alaskan clients.

With White social workers serving large numbers of minority clients, the need to develop the skills for culturally sensitive practice

becomes even more relevant. JOINT STUDY BY THE CENTER FOR HEALTH WORKFORCE STUDIES AND THE NASW CENTER FOR WORKFORCE STUDIES (2006),

How Does Racism Impact Your Clients?

‣ Racial stress is cumulative ‣ Experiences of harassment, discrimination, and

poor treatment compound and lead to poor health outcomes

(Carter, 2007)

Your Client’s Experiences of Racism ‣ Clients experience racial microaggressions in

therapeutic settings as well

‣ Therapists may unintentionally be harming their clients by dismissing claims of race-based traumatic stress, approaching client interactions from a color-blind socio-emotional framework, and being unwilling to discuss racial issues

‣ Discussing racial differences and experiences early within the relationship can build trust within the therapeutic setting

(Constantine, 2007; Neville, Tynes, & Utsey, 2009)

Understanding Racism in the Mental Health System

Organization

Ideas of Superiority Social Norms

Individual Attitudes Feelings

Behaviors

Structure/System MH System

Media Education

Policies & Procedures

Assessment

Diagnosis

Treatment Planning & Treatment

Ineffective Models of Care

Impact

Not always recognized, the lack of cultural sensitivity among providers and inability to deliver culturally

appropriate services results in the providers failure to deliver competent care and contributes to the

experiences by minorities that traditional mainstream services are not relevant and/or helpful

leading to their disengagement and/or being underserved.

Impact • Distrustful (Smart, 2010) • Fear– similar to problematic contact with police, justice

system • Stigma associated with labels that “White” providers give

to minorities • Irrelevance of services

Attitudes

• Delay or fail to seek mental health treatment • No Show for appointments • Utilization of higher end services • Lack of follow through with treatment recommendations • Terminate treatment prematurely

Behaviors

What Can Organizations Do?

What Can Organizations Do?

What Can Organizations Do?

Name & Frame

Educate & Initiate

Attract & React

Thread & Embed

Name & Frame ‣ Naming and framing is about identifying the core elements of the

ideology, frames, manifestations and racial practices that tend to be subtle, institutional, enduring and perpetuated against people of color.

‣ The ability to understand the “frames” offers perspective to the depth of the problem and the impact institutional racism has had on systems and communities.

‣ An organization must be willing to acknowledge and accept the history acknowledging the multigenerational effects of racism and the social structures that have limited an individual of color ‘s ability to achieve maximal human potential.

Name & Frame • Assign a key organizational leader to engage in efforts to raise

awareness of the impact of racism and racial inequities in your organization among staff.

• Utilize data to start the conversation about addressing potential inequities in your organizations.

• Identify areas of racial inequity you want to address and integrate it prominently in your messages to stakeholders, the media, and the public.

• Be diligent in monitoring for continued behaviors of discrimination, either overt or covert.

Educate & Initiate ◦ Invest in learning that deepens one’s knowledge and understanding of the cultural

backgrounds and lifestyles of various racial/ethnic groups. Help providers recognize that that when working with culturally and ethnically diverse individuals/families, it serves to enhance the capacity of both the individual/families and practitioner.

◦ Increase staff understanding of the relationship between racism, social condition and health outcomes.

◦ Support staff to provide care that does not vary in quality based on the personal characteristics of an individual.

◦ Create a culture of ongoing learning and professional growth regarding a providers own self awareness of their cultural orientation and its impact on their work.

◦ Develop/support innovative and creative health promotion strategies which reflects the need to address issues like stigma, shame, fear, uncertainty, and distrust that affects all stigmatized groups

Attract & React ‣ Organizations must make a targeted effort to develop

participatory, meaningful relationships with natural helping systems in communities of color such as churches, community leaders, extended family members, healers, and others.

‣ Organizations need to engage in aggressive equity hiring practices, which target clinical and management staff from diverse communities, who are representative of the populations served.

‣ Identify shared values with communities of color ‣ Pursue sources of funding and services that more fully

reflect the needs and wishes of the community

Thread & Embed ‣ In order to change organizational culture, organizations need to

legitimize anti-racist practices in policy, structure, practices, procedures, & resources.

‣ Establish a racial equity lens that is woven into the fabric of the organization so that all staff are attuned and responsive to addressing inequities.

‣ Hire, promote, and develop staff who can implement the vision. ‣ Set bench marks and measure progress at regular intervals. ‣ Commit to changing systems or structures that undermine the

vision. ‣ Articulate the connection between new behaviors and

organizational progress/success.

The Texas Model – Racial Equity in Child Welfare Removals

‣ “The Texas Model for the Elimination of Disparities and Disproportionality” targeted eliminating the disproportionate number of African American and Native American children in the foster care system.

‣ The Texas Model is a set of principles that led to proven outcomes when applied rigorously and consistently across an organization:

1. Leadership Development; 2. Development of a Culturally Competent Workforce; 3. Community Engagement; 4. Cross Systems Collaborations; 5. Training Defined by Anti-Racist Principles; 6. An Understanding of the History of Institutional Racism and the Impact on Poor Communities and Communities of Color.

Under the leadership of Joyce James, Assistant Commissioner of Texas Child Protective Services, the State of Texas actually began to see a reduction in the disproportionality between white children and children of color, as well as a reduction of child welfare removals for children of all races. All of this was done without reducing the safety of children who were able to remain with their families and communities.

http://www.antiracistalliance.com/SWPIRacialEquityReport.pdf

(Texas Department of Family and Protective Services, 2010; 2011).

http://www.antiracistalliance.com/SWPIRacialEquityReport.pdf

Preliminary Protective Hearing Benchcard ‣ The PPH Benchcard asks judges to both reflect on the decision-

making process in order to protect against institutional bias and to consider some key inquiries, analyses, and decisions relating to child removal, placement, and services.

‣ Ask yourself as a Judge: What is my understanding of this family’s unique culture and

circumstances? How has the court’s past contact and involvement with this family

influenced my decision-making process and findings? How have I integrated the parents, children, and family members

into the hearing process in a way that ensures they have had the opportunity to be heard, respected. and valued? Have I offered the family and children the chance to respond to

each of the questions from their perspective?

‣ Courts Catalyzing Change Study

http://www.ncjfcj.org/sites/default/files/CCC%20Benchcard%20Study%20Report.pdf

Racial Equity Resources • Peoples Institute for Survival and Beyond http://www.pisab.org • Crossroads Antiracism Organizing and Training http://crossroadsantiracism.org • Bias Implicit Tests https://implicit.harvard.edu/implicit/selectatest.html ‣ https://www.socialworkers.org/diversity/institutionalracism.pdf ‣ www.Unfaircampaign.org ‣ http://www.ncjfcj.org/sites/default/files/CCC%20Benchcard%20Study%20Rep

ort.pdf ‣ http://www.antiracistalliance.com/ ‣ https://www.youtube.com/watch?v=hrFxGByiBRs ‣ http://www.buzzfeed.com/jessicamassa1/do-you-have-a-racial-

bias?utm_term=.qp14plA0XN#.cgooy6Yq3e ‣ http://www.buzzfeed.com/dayshavedewi/what-is-

privilege?utm_term=.th7WDVxPNY#.haBZzNG5vX

http://www.pisab.orghttp://crossroadsantiracism.orghttps://implicit.harvard.edu/implicit/selectatest.htmlhttps://www.socialworkers.org/diversity/institutionalracism.pdfhttp://www.Unfaircampaign.orghttp://www.ncjfcj.org/sites/default/files/CCC%20Benchcard%20Study%20Report.pdfhttp://www.ncjfcj.org/sites/default/files/CCC%20Benchcard%20Study%20Report.pdfhttp://www.antiracistalliance.com/https://www.youtube.com/watch?v=hrFxGByiBRshttp://www.buzzfeed.com/jessicamassa1/do-you-have-a-racial-bias?utm_term=.qp14plA0XN.cgooy6Yq3ehttp://www.buzzfeed.com/jessicamassa1/do-you-have-a-racial-bias?utm_term=.qp14plA0XN.cgooy6Yq3ehttp://www.buzzfeed.com/dayshavedewi/what-is-privilege?utm_term=.th7WDVxPNY.haBZzNG5vXhttp://www.buzzfeed.com/dayshavedewi/what-is-privilege?utm_term=.th7WDVxPNY.haBZzNG5vX

Racial Equity Resources • 2011 National Healthcare Quality and Disparities Reports

Http://archive.ahrq.gov/research/findings/nhqrdr/njqrdr11/minorit.ht

ml

• http://www.commonwealthfund.org/publications/press-

releases/2003/mar/minority-americans-lag-behing-whites-on-nearly-

every-measure-of-health-care-quality

• http://www.nymbp.org/uploads/2/6/6/0/26609299/whiteprivilege.pdf

http://archive.ahrq.gov/research/findings/nhqrdr/njqrdr11/minorit.htmlhttp://archive.ahrq.gov/research/findings/nhqrdr/njqrdr11/minorit.htmlhttp://www.commonwealthfund.org/publications/press-releases/2003/mar/minority-americans-lag-behing-whites-on-nearly-every-measure-of-health-care-qualityhttp://www.commonwealthfund.org/publications/press-releases/2003/mar/minority-americans-lag-behing-whites-on-nearly-every-measure-of-health-care-qualityhttp://www.commonwealthfund.org/publications/press-releases/2003/mar/minority-americans-lag-behing-whites-on-nearly-every-measure-of-health-care-qualityhttp://www.nymbp.org/uploads/2/6/6/0/26609299/whiteprivilege.pdf

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How Racism Impacts Those We Serve and How We ServeHow to Obtain Your Continuing Education Contact Hour for this WebinarOverviewRace – a Social and Political ConstructHuman Genome ProjectRace-based Human HierarchyRacism as a Historical IdeologySlide Number 8What Do We Mean by Racism?Common Examples of Individual Racism and Racial Microaggressions RacismStructural Racism �(i.e. Institutional Racism)Polling Question!Why is Thinking About Racism Important?Racism is a Chronic Life StressorRacism is a Chronic Life StressorSlide Number 17Why is Thinking About Racism Important as a White Person?Why is Thinking About Racism Important as a White Person?Let’s Chat:White PrivilegeThe White PrivilegeThe White PrivilegeThe White PrivilegeRace within the WorkforceHow Does Racism Impact Your Clients?Your Client’s Experiences of RacismUnderstanding Racism in the Mental Health SystemSlide Number 29Ineffective Models of Care�ImpactImpactWhat Can Organizations Do?What Can Organizations Do?What Can Organizations Do?Name & FrameName & FrameEducate & InitiateAttract & ReactThread & EmbedThe Texas Model – Racial Equity in Child Welfare Removals��Preliminary Protective Hearing Benchcard Racial Equity ResourcesRacial Equity ResourcesLet’s Continue the Conversation!How to Obtain Your Continuing Education Contact Hour for this Webinar, cont.Contact Us