So I'd like to welcome you all to this amazing seminar on how to teach with an anti-racist perspective. And I've been really honored this last year to work on the task force for the APA on the social determinants of mental health. And we've prepared a document that'll be up shortly on our recommendations to the APA. But I have had the wonderful immersion learning experience of working with Dr. Kimberly Gordon-Akibe, who really is so, so thoughtful and so advanced on understanding what our next steps need to be. So I have nothing to disclose. So I am a white person, so I have some white privilege. And I'm going to talk about how I became aware of that and how I continue to try to enact that and make the conscious decisions that are required. Racism, it's not about only individual actions, but the powerful policies, the structure embedded in our society is racist as well. Interpersonal racism can be an aggression, a microaggression. It's between two persons. Institutional racism really, really has so much power. These are the things that we need to understand when we address structural racism, which you've heard a lot about today, no doubt, but goes back to ways that keep people disadvantaged. So no one is born racist or anti-racist. The choices we make will define us. So it's about what you do, and I'm saying it's about something you can learn. You can learn to be anti-racist. I have this quick picture of my mom, Edna Tett, Malaspina, and I was most, most fortunate and blessed to have this woman be my mom. She was not so fortunate or always blessed. She was one of eight children from a large immigrant family. She and one brother were put in an orphanage for a few years during the Depression. It was a black orphanage largely in Brooklyn, and she did fight constantly to get back home, her brother told me, and getting back home, this little tiny pipsqueak, skipped a bunch of grades to graduate with her older sibs, which they did not like, was actually accepted to medical school, but not allowed to go. And so instead, she forged a birth certificate, joined the army, trained as a cadet nurse, and she never, ever stopped caring for all children, and she was an activist. I mean, she understood that people were people. Now, I went to an all-white high school, now it's 17% white, but in that town, my teachers were active in the Newark riots and in the Jersey City riots, and they were there at night, and they were back in the classroom with us, telling us why there were riots. Our reading in high school was black authors in this all-white high school. That was what we read, that was what we talked about, that was what we came to understand. I went to Boston University and amazingly ended up with history courses with Howard Zinn, at the time considered a radical left historian, but he wrote A People's History, the most widely read history book, and I've encountered other things along the way to show how marginalization can be accomplished. Finally, now at Mount Sinai, I am the vice chair for DEI, we have an amazing, thriving, amazing committee, and I'm really honored, very honored to be on this task force. Here's some of the things that kept us glued to the television set, because between age, I was born in 52, so between 1963, the story of our lives was what's going on with civil rights. You know, I remember each of these events like it was yesterday, and I remember losing Martin Luther King, my mother sobbing and sobbing, and then JFK, and thinking how can we really go forward again, but here we are. My daughter was training in public health nutrition, working with inner city kids who had obesity and diabetes, when she got into medical school, and she said, oh, how can I look downstream and make a difference, so she's a primary care pediatrician, and the last thing I'll note is my husband just got his first federal grant, he's a lawyer, and it's to recruit people of color into the FBI, CIA, and Homeland Security to start changing those systems, so I mean that's a little bit about why I'm here, but I want to say the dean of our medical school made a few comments that really moved me. He said, among other things, that we have taught you in addition to science and medicine, social justice. This must be your commitment throughout your whole career. Physicians and scientists play an essential role in working toward the common good of society, because we bring moral passion to our work. The degree you're receiving today is more than a diploma, it's an ethical contract to serve humanity. It comes with great responsibility, and this final sentence, fight racism and bias in medicine and science, work for health and social justice, and I'm still trying to do that, and just honored to be a part of this symposium, so let me introduce Dr. Forrest again. Thank you everybody, so I'm honored to be a part of this panel. Am I the only non-child psychiatrist up here? Okay, I'm a CL psychiatrist, but I'm here because of my role as the chief of diversity for the department of psychiatry at the University of Maryland, and I think that as we proceed through the rest of the talk, Dr. Gordon, Dr. Beeson, Dr. Hahn, they're going to talk about the aspects of curriculum in the Child and Adolescent Psychiatry Fellowship, but one of the things that we have recognized is that you need to build a framework to make this actually come alive and be real, and so that's what I'm going to talk about. So what we are sort of engaged in at Maryland is a process of change management. Diversity means many different things to many different people, and so we needed to spend some time clarifying what it meant for us, and to really set some priorities in order to be clear and specific about our goals, and again, DEI and social justice are goals for our organization, and our leadership, meaning our chair and our division directors, are committed to change around DEI, and we need to talk about like the makeups of our organizations and our institutions and why personal commitment to social change and social justice is critical in the leadership levels, because what happens is when we're sort of instituting new changes to curriculum, changes to curriculum, it can seem like it's a very one-off thing that's cared about by the people who are committed to DEI if the organization is not fully committed, and on the side here, there's just a graphic that I've created to describe like the process of change, really starting with awareness, maintaining people's interest and curiosity, engaging them, talking about being honest and reflective when we're doing action, and then creating initiatives that are sustainable and can grow. So we, like many departments, did a department-wide needs assessment to kind of figure out where we were. It's amazing to understand that lots of departments do not see racism or understand that anti-racism curriculum is important, and so part of a needs assessment is really to like help people to see what many of us maybe see or experience when they do not, and really to then foster some of that active participation that we were just talking about. So what we figured out was that we weren't doing so well. We used a lot of surveys, focus groups, we started courageous conversations, which are like many of the conversations that people maybe have been exposed to in these past two years, talking about race and racism and identity and social justice in a formalized arena rather than just in informal settings, and we started to identify members of our department who had interests in DEI, not only interest but the background and knowledge that could help us move forward. Enter Dr. Gordon, Dr. Beeson, and Dr. Hahn. So one of the things that I want to stress about change management is sort of thinking about core values of organizations. How would somebody who's just entering an academic institution understand the values, especially when it comes to DEI, anti-racism, and social justice? Thinking about what the gaps are between what we say our core values are and how we interact with each other every day, the history of our organizations, and then what the challenges are, and talking about those in a real way. So we have a diversity committee. A lot of people have a diversity committee. I think it's important to understand why a diversity committee is important, right? So problems can be subtle and diffuse. People don't understand them all in the same way, and what happens in academic psychiatry, very specifically because we've been talking about social justice and DEI issues for a long time, is that we realize you need to have a sustainable infrastructure to maintain this. DEI efforts in the past have been very segmented and isolated because the organization, the institution, did not find it to be as valuable as the academic pursuits, right? And so we needed to really say formally like this is what we care about. Faculty recruitment and retention, staff recruitment and retention, specifically for underrepresented minorities, social justice curriculum and education, which is what we're talking about today, research, and then community outreach and engagement. You must name it, you must put resource towards it, and you must get people to be actually involved. And so for social justice, we really did like what a lot of other institutions did. We had a lot of grand rounds. Here is just a sampling of some of the speakers. Dr. Vinson, who gave an exceptional talk today, came to talk to us. And one of the things that I want people to understand is that this is really a starting place. Trainings, education around DEI and social justice issues are important, but again, there is a certain sense that it must be personal and real to then be carried out into our clinical work. So we can have as many talks as we want to have, but if people don't value the talks, if like at our institution, people attack the people who create the series and say, well, you're trying to dethrone whiteness and attack white people, that can be something that is not really useful or helpful for what we're trying to move forward. And what we're trying to do is create anti-racism education. So a QI toolkit so that people can address actively DEI issues in their workplace. Education resources for high yield topics so that people can self-reflect and educate rather than burdening minorities to do that for them. Making anti-racism education an integral part of our department learning. So that's faculty, not just residents and fellows. Faculty must start to then remediate and understand what they do not know so that they can actually be more effective in teaching trainees. And then really aligning our education that we do for trainees with GME requirements, which are just now starting to become a little bit more crystallized. They've been real vague and diffuse before now. So with that, I will introduce Dr. Gordon. So I have a little pressure because I have new trainees coming into the University of Maryland here. So thank you guys for coming, some incoming fellows. And also just thank you guys for being here. How many people in the room are child and adolescent psychiatrists? Wow. You know, when I started the APA, one of the things that was really important to me is to have the APA have child psychiatry curriculum or child psychiatry interests inside of the APA meeting. And that was a little bit of challenge back in the day. But because I was a SAMHSA fellow leader for the APA, and I also want to be a child psychiatrist, I've spent most of my career doing work for the APA, right? And I've seen a really big transition in terms of our conversation around structural determinants of mental health, social determinants of mental health, anti-racism. Ten years ago, I'm sorry, you guys, that just wouldn't have been possible. This room would have been smaller. It would have been mostly black people in the room, and it would have been marginalized because it would have been set in the room where no one wanted to walk further away from. That was my experience when I became an APA SAMHSA fellow. I, in 2018, developed a microaggression learning lab, and I just saw the energy and the change that was happening within the organization around addressing these issues. However, what happened? What happened after 2018 COVID, right? And COVID really showed us on a big scale what's happening in our country and why we need to make anti-racism and anti-black racism a priority because social determinants of mental health are impacting them in a way that's decreasing their lifespan, right? And so my indelible mark is to really be an agent changer and really engage in education and clinical education in a way where we increase the lifespan of the most marginalized among us. And obviously, we may have some international people here who are coming from other countries and may not understand or appreciate the racial stratification that we have in our country, yet may appreciate social determinants of mental health. And we'll talk a little bit about some of those social determinants of mental health. I have Dr. Tiffany Beeson here because I realized, based on my lived experience, that I could not do this work by myself. I have lived so much trauma because of racism that to do this by myself, I would just like lose it. So having that support, someone to call and Dr. Forrester to call, who actually championed for me to be at University of Maryland, so I have to give a lot of honor to her to just say, Kim, you've been in academics for a while. Why don't you come back and do this? You know, don't give up. And so having that tribe is really important. So we're going to talk about a pathway forward for addressing curriculum gaps in child medicine psychiatry. We understand the charge that Dr. Pender had to have a social determinants of mental health task force following the structural racism task force that was the year before. So this movement will continue, and it's going to continue because of members like you. And we also want to honor Dr. Dilip Jesti, who was our chair for that. So the research and education work group came together with the APA social determinants of mental health task force to develop a way to move forward. We invited program directors, administrators, people across this country who are leaders to be a part of our subcommittees and give us input on how to move forward. And we really felt that it was important to think about clinical education with public health, clinical and policy involved. So what are our policy interventions as well? And we decided to divide ourselves up into these categories that you see here. However, I never joined a project without knowing what it entails. And even when you do your vetted research to figure out from an equity lens if you can do the work, you may come across some challenges. But what was really important to me is really to get, I guess I would say, the beat of the street, because residents and fellows have been for a lot of times championing social justice in their curriculum. And they are the ones who are creating these op-eds and really early career psychiatrists making it possible. So we actually decided to do a focus group with our resident and fellow leaders for the APA. And there are two groups that are really important to me within the, all of them are important, but those two groups is where I center myself for the most part. And that's the public psychiatry fellowship leadership program with the APA and also the minority fellowship program where they have the Sampson diversity fellows. So those are the two groups that we center our energy on, but all of the leaders of the APA foundation fellowship programs participated in the survey. And this survey that we gave to them asked them a lot of questions about social determinants of mental health based on their perspective in their training programs, but also what their experience has been within the APA. And I can't go through all of those things, but we were very intentional to include the social determinant of social inclusion and freedom from racism and discrimination. So we asked specific questions about that to get their input as well. I have to say that I am from New Orleans, everybody. I was born in New Orleans. I was born at Tulane University and I became a professor at Tulane, assistant professor at Tulane University and did medical school residency fellowship. And so it's an honor to be back in my hometown. And it's also true that I never thought that I would be here today speaking in front of you this way. What my goal was in life was to be a doctor. And the reason why I wanted to be a doctor is because my mom told me that she almost died at Charity Hospital, which was a historical hospital in New Orleans, because the discrimination that was happening at Charity Hospital. I was supposed to be a twin. Someone said, you need to go to a specialist at Tulane or you won't, you know, you won't, you won't have this baby. And so Tulane helped save my life. And so I wanted to go to Tulane and be a doctor. So it really is feeling good today. I also have to say that I'm getting the Jean Spurlock award and I like to honor myself and celebrate myself. So it's a blessing to be here today. It's a full circle for me. But now I live in Baltimore and I guarantee you those social determinants, mental health things that I've felt and experienced in my childhood, I also see in Baltimore. And Maryland has a lot of great things that's going on, but we also have child bargaining, right? And we have crime and we have violence. So we have kids who are living in homes that really they should not be living in this day and time. But we also have kids that's going to schools that just don't have what they need. We have some schools where kids were having to be placed in multiple kids, multiple schools are placed in one building so we can rebuild the infrastructure so kids can have AC and those type of things during the week. So I put this slide in here to be intentional. While I continue to talk about DEI and serve as a DEI champion for the Division of Child Psychiatry for the University of Maryland and also in the Social Determinants of Mental Health Task Force, caring for myself is not indulgence, self-indulgence, right? I grew up thinking that I had to care for other people. That's why I wanted to be a doctor. And I have championed DEI in a way that really shortened my telomeres, okay? You guys know what telomeres are, you're doctors, right? And so I'm trying to figure out a way to keep me here and increase my lifespan. So that's why we need you and we need other people to take a part of this, okay? So University of Maryland did something that was wonderful. They actually did a survey for all program directors of all specialties and they asked them, what are you doing around social determinants of mental health? And what are you doing around systemic racism? And these were the responses here. And sadly, you know, although this looks pretty like average for like other places, we really could be doing a lot better across the country. We really should be seeing more like 80% considering the patient population, particularly that we have in Baltimore City, right? So this graph, it may be a little bit busy. I hope you can see some of it, but I just want to give you some ideas of some of the questions that was asked. So have you had a supervisor who's underrepresented minority, right? Many people, that's important to them. That's how we have these conversations. Have you had conversations around social determinants of mental health? Or do you feel like your population that you work on is doing those types of things? So those questions were really important. And I think the narrative that's important to me that although fellows generally felt faculty were supportive, when they raised concerns or heard questions during the COVID pandemic around racism, there was silence. People didn't know how to have those conversations. They felt uncomfortable. And we all were sitting in front of our TV seeing what happened with George Floyd and the Black Lives Matter movement. I'll say that 1968 was what you experienced, but the Black Lives Matter movement for 2020 was my civil rights journey. And I think we're all kind of still figuring out how to do that better. So University of Maryland, as we mentioned before, developed an infrastructure for DEI. And in the infrastructure, the Social Justice Education Curriculum Committee, which I co-chair with Dr. Anne Hackman, who's a community psychiatrist, we developed these objectives and strategic plan to move forward. And part of that was actually developing QI projects in addition to quality improvement projects, in addition to curriculum development. And this is just a picture we have to show where I kind of center myself within the department. And I'll show you a little bit more about my process of actually saying, can I do this? And do I want to do it? Can somebody else do it? Let me give it to somebody else. So anyways, these are the articles for me that was really important to understand social determinants of mental health and child and adolescent psychiatry. Dr. Hal Kornsberg did an analysis of all child psychiatry training programs through Frida online and asked people what was happening in their curriculum, in addition to racism as a unique social determinants of mental health. And we can't forget about our Social Injustice and Mental Health textbook, I call it a textbook, it's not a textbook, but it's a really great book to read, by Ruth Shim and Sarah Benson, who spoke today, who was really helping us understand this a little bit better. And also Enrico Costello, who did an article on how we can use our milestones, how we evaluate residents and fellows, to understand systems-based practice, and what that means to be a health equity advocate. I'm moving a little fast because I want to get to the curriculum. Okay. So, but you can't have curriculum as a faculty member unless you're a publisher. That's what I was told when I was starting out, and I was offended by that, because when I started, nothing that I wanted to talk about was published in any journal. But that times are changing, and you can see as evidence here, the Clinic's Journal for Child and Adolescent Psychiatry did a whole book in April 2022 on addressing systemic racism and disparate mental health care, and I'm in there with the article, Nutrient Children, Child Mental Health, and Body and Soul, and we have another publication that's coming up on the color of child protection, anti-racism, and abolition in child mental health. So I encourage you guys to support and read, and ask us questions, and challenge, actually, what's been discussed. So these were the overarching themes for our curriculum, and these overarching objectives was meant to really engage people in self-reflection, right? And lifelong learning, which is critical for our work. So teaching about implicit biases and unconscious bias, it's not old, it's still relevant, but that's an individual level. We wanted to advance it further, to actually go more upstream and think about structures. Structural competency, structural humility, and those things, and the like. And also think about policy interventions in your community. In Baltimore, unfortunately, we do not have kids catch school buses, right? So if you have kids who are afraid to go to school, many of our kids are not going to school because they're afraid to go to school, and no one is picking them up. Or if the transportation comes, which is a taxi cab, they're coming late. So that is a challenge for me as a child psychiatrist, to know that kids can't get to school. And I live in Howard County, which is one of the wealthiest counties in Maryland, and I see those kids who are safe to go to school, or may have transportation. So those policy interventions are actually really important. So just a little bit about our didactic curriculum. This curriculum is not unique. Many people have topics similar to this, and this is what we were able to do this year. But what I thought was different, in terms of helping with the equity and the task that many women of color or people in marginalized groups, LGBTQI community, are tasked with, is developing this curriculum without support. So we thought it would be nice this year to invite some special guest lecturers. But they came for Grand Rounds, but in addition to them coming to Grand Rounds, we invited them to spend time with the residents and fellows afterwards. We felt that they would help us teach our residents and fellows how to move forward with this curriculum. We also developed a social justice champion. And actually, Crystal Hunt, who will be speaking later, was our social justice champion chief this year without knowing it, because it was an official title. But we developed a social justice champion who's now here, Tripti Sunny, who's in the thing. So that is really important for us to have residents and fellows to be a part of curriculum development, and we'll talk about that a little bit later. But our special guest has special themes, and really helped engage in this curriculum development. And Dr. Mary Lou, who spoke about social determinants a little bit later, was a part of that group, in addition to Helen Hansen. What I thought was important in terms of guiding our workforce, and actually engaging in the interdisciplinary approach of evaluating psychiatrists, is to really understand that we can map social justice, we can map social determinants of mental health, and anti-racism and trauma-informed care, and what we evaluate. Has anybody here heard of entrusted professional activities? If you're a surgeon or an internal medicine doctor, you'd probably know more about it. But one of the things that we're required to do is entrust people to go out and do something, like informed consent, so consent for medication. Why don't we entrust people to do something like a cultural formulation interview? Before you graduate, you need to know how to do one, and I need to see you do it. And so this is just an example of how we can use our problem-based learning milestones, and professionalism milestones, and others to do the work. Again, quality improvement projects are also very important, and so we have our residents engaged in quality improvement projects, and this quality improvement project was done earlier, was supposed to presentation that talked about a toolkit by which faculty and residents can use, with glossary and terms, and also project ideas that can help them understand what DEI is all about, and how does it work. So here are the steps to develop an anti-racism, social determinants of mental health curriculum. First, you want to develop an infrastructure, thank you Dr. Forreston for doing that. You want to advocate for policy change to address social determinants of mental health. You want to take action beyond the walls of your clinics, hospitals, and treatment centers. Communicate and share understanding of DEI, that's really important, because until we're speaking the same language, it would be impossible to get anything done. And you also want to foster these key stakeholders to be involved, DEI experts, and that's what we did by inviting those experts to come to the University of Maryland. And again, promoting curriculum development is a lifelong process for us. So what will be your story? Again we, if you see this picture here, we all have a story to tell, we all have a part to tell, but it's really important to get the big picture, all of our stories matter, but we need to come together to recognize and appreciate that. So the challenges ahead is to commit to DEI related action in the next week. And what would you do, what action would you take? Make your own choice, manage your self-care, and this is just a little picture about me, so if you want to look me up, you can do that. And now I'm going to have, move fast you guys, I'm sorry I'm rushing, I want to make sure you have time to ask questions. Now I have Dr. Tiffany Beeson who's going to tell us a little bit about what happened when we taught this class. All right, I'm Tiffany Beeson, I am assistant professor at the University of Maryland School of Medicine, I am a clinical and community psychologist, and I am faculty at the National Center for School Mental Health, as well as the National Center for Safe Supportive Schools. And I am going to be, well first I don't have any financial relationships that I need to disclose and I have an outline of what I will cover today. I will introduce the CARE framework in just a moment, which is the framework that I work from in the National Centers for School Mental Health and Safe Supportive Schools, and then I will dive into the core competency and humility elements of the curriculum that we developed and share about our evaluation plan findings and next steps, and then also share some of the strategies that we use to increase the fellow engagement in the learning process during the curriculum. So at the National Center for Safe Supportive Schools, I am the director of cultural responsiveness anti-racism and equity, which I define here. Cultural responsiveness in schools is about intentionally including students, families, and educators' cultural and identity-based values, norms, beliefs, languages, etc. into aspects of schooling, including academic lessons and mental health supports. Anti-racism in schools is all about involving, intentionally promoting school policies and practices that oppose racism, and I always note that being anti-racist is much more meaningful than claiming to be not racist, which does not involve any action. Anti-racism, on the other hand, is all about action and actively doing the work to promote racial equity. And then finally, equity in schools refers to ensuring, and within all of our systems, refers to ensuring that every child, family has what they need, not necessarily what is equal, but what they need to be well and to thrive. And I wanted to highlight this framework because it basically defines the framework that I work from, and in my collaboration with Dr. Gordon in supporting the development of the curriculum for psychiatry fellows, and it's also kind of the framework that I take to the work that I do with Dr. Gordon and under the leadership of Dr. Forrester in my role as a co-chair for the Social Justice Education and Curriculum Committee at the Division of Child and Adolescent Psychiatry level, and also in my work with Dr. Gordon in supporting the Education Administration and integrating DEI and CARE into the training curriculum for residents. All right. So a moment ago, Dr. Gordon walked you through the structure of the curriculum, and so I wanted to share what the core areas of competence and humility were for this curriculum that is seeking out to advancement in psychiatry fellows' competency and humility in these specific areas. So understanding of diversity, equity, and inclusion core knowledge and frameworks, engaging in cultural responsiveness, that is, responsiveness to the needs of diverse populations, including those from communities impacted by historical and present-day injustices, serving as an advocate for health equity in their clinical practice, being able to identify and address structural barriers to providing culturally responsive care to specific populations, and understanding their own biases and how they impact their medical decision-making as well as patient care. So those were the core outcomes of interest with the development of this curriculum. And the way that we evaluated the curriculum is we had a very simple and feasible evaluation plan where we administered online anonymous surveys to the fellows, and we gave them an opportunity after each seminar to basically rate how well the facilitator met the objectives of the seminar, but also we gave them an opportunity to rate how much they felt that they grew in terms of their competence and humility related to those core domains. So they rated these items on a scale from 1 to 5, and 5 indicating that they strongly agreed that they were able to develop in advance following participation in the seminars. And I know this table is a little bit overwhelming, it's a bunch of numbers, but what it basically – it lists the areas of competence or the specific items that the fellows responded to for the seminars that they attended, and as I mentioned earlier, this is a 1 to 5 point scale, and on average, the fellows indicated that they felt they either agreed or strongly agreed that their level of understanding increased, that their ability to be responsive to the needs of diverse populations and serve as an advocate, as well as identify and address structural barriers impacting their patients, and then their ability to understand and manage their own implicit biases improved as a result of participating in the trainings. And this is just a table that shows all of the areas of competence and humility that's ranked based on the fellows' reports of how well the curriculum supported their growth in these areas, and as you can see from the table, the top two areas of competence and humility where the fellows reported the most growth were increased understanding of diversity, equity, and inclusion core knowledge and frameworks, and then increased understanding of their own implicit biases and how they impact medical decision-making and patient care. And so, these are the seminar topics that were most impactful on the fellows' growth per their report, and so it includes participation in a case conference that was intentionally focused on training fellows on how to use an anti-racist social determinants of mental health lens and thinking about the needs, case conceptualization for a patient, as well as a treatment plan for a patient. And then the seminar focused on a Vietnamese-American's account of bipolar recovery, seminar focused on Asian mental health and psychotherapy, one focused on equity travelers that really looked at the impact of engaging in DEI championship on the wellness of equity travelers and what to do to be well in the process of championing this work, and then a seminar that focused on a critical analysis of cultural humility and concrete practices to foster cultural responsiveness, anti-racism, and equity in healthcare. So those were the ones that got the most positive responses from fellows. So here's a summary of some key findings from our evaluation, and then some next steps. So on average, the fellows responded very positively to all seminars, and they were most favorable of seminars that focused on applying the skills that they were learning about frameworks and definitions to case conceptualizations. And then also seminars that were focused on a specific population, specifically the Asian-American population that Dr. Han will be speaking about a little bit more as she led a lot of that work. And we thought that this was the case because it gave the fellows an opportunity to take a deeper dive into these concepts and structures and how they impact a specific population and what they can do in order to provide high quality care for Asian-American patients. A next step for the curriculum is that we really want to be intentional about integrating seminars on how fellows can engage in systems change to address structural barriers. That was one of the core areas of competence and humility that fellows felt less prepared to do. And so in doing so, we want to incorporate trainings on how fellows can interact with different systems such as social services, juvenile justice, school systems that impact social determinants of mental health in order to advocate for changing systems. And then as far as next steps for evaluation, we want to use pre-post-test administration to really track changes in knowledge, skills, and attitudes, as well as engage fellows in conversations like focus groups to collect more qualitative data about the impact of this type of training on their competence and humility. And then we also want to integrate survey items that don't just ask about what knowledge or attitude you have, but we want to ask specifically about what behaviors are you engaging in? What specific clinical practices are you engaging in that are aligned with this anti-racist approach to care? All right. I'm going to be two more minutes. Is that okay? Oh. I'm going to... I think we're going to have the slides available at a later time, so I'm going to skip to my colleague Crystal Han. Hi, everyone. My name's Crystal Han. I am a second-year child fellow at the University of Maryland, and so I'm almost done. Yay! It's been a long journey. I am an APA SAMHSA Minority Fellowship recipient as are alumni of that program, Drs. Gordon and Forrester, and I'm really lucky to have come across them in my journey as well as their encouragement in part of this program because it has done a lot to support the work that I'm going to be sharing with you. So throughout all of my training, I did adult training at University of Maryland as well. We work with a really diverse, often marginalized population in Baltimore. It's a unique program because a lot of our work is with kind of marginalized, mostly black, very low SES populations in West Baltimore, but we also see a larger diversity of at Shepherd Pratt, which is in a kind of suburban area of Baltimore, and so we actually do get quite a diverse array of patients. And during my training, I have often felt there was a need for a more continuous, in-depth, comprehensive training in social determinants of mental health, anti-racism, and cultural psychiatry. Our experience with the concepts of social determinants of mental health was really varied among child fellows because we come from all these different adult programs, and so obviously it's really highly dependent on the curriculum set in your adult training, which is not standardized of what we are starting points in terms of when we get to child fellowship. And prior to Dr. Gordon's arrival, there was really no dedicated curriculum or lectures about social determinants of mental health in the child fellowship at all. And so our lectures and our readings were really sporadic, really limited on all of these issues. In terms of the pedagogy, often our instructors are kind of reading off PowerPoints with not that many case conceptualizations, not that many discussion-based lectures, which really after kind of the interventions we were discussing earlier are a lot more engaging, especially with media presentation, case examples, spurring more discussion and engagement, and as Dr. Gordon mentioned, things that are very salient and personal that gets that personal investment and stem from personal experience, and sharing that is really a lot more effective in our learning. There was also really limited to no dedicated time for underserved special populations, such as AAPI populations, which is my passion, but in addition to that, immigrant, refugee, LGBTQ plus mental health is still, I feel, places that we have room for improvement in terms of special populations that deserve more attention. In terms of mentorship, academic mentorship, both nationally and locally, I really had to go out of my way early in training to find people like Dr. Forrester, and I think that that speaks to the very much need of both better representation in faculty and staff, but also the need for improvement in faculty development so that the baseline competency in supervision that we get is increased so that anyone from any background is better versed in supervising and modeling these ideas clinically, and that involves resources and time for faculty development as well, and I think that is really important. And lastly, trainee involvement. I think that the trainees that feel really powerfully about these things will kind of search for these on their own, but in my experience that I'm going to share with you, I think there's huge potential to involve trainees in all of these levels, and even outside of training in terms of community engagement and doing this work and policy advocacy, and so there's a huge kind of untapped potential, I think, in involving trainees in curriculum development and putting that work into action. So these are a few of the things that I'd like to share with you that I was able to participate in in my time in training. As I said, I had a specific interest in AAPI mental health, and so we undertook a few different interventions supported by my APA fellowship. So the first was developing a culturally sensitive AAPI curricula for CAP trainees. I also had started with an adult psychiatry resident peer, a local AAPI affinity groups, one at Hopkins and one at University of Maryland called Crazy Stress Asians. We really utilized this for both personal and professional development of kind of like exploring some of these themes and then also bringing what we learned into our work as well, which was really powerful. I was able to get involved in a few scholarly activities, including publishing a manuscript on the above AAPI curriculum, as well as presenting a poster on that at various research days and conferences, and I was also able to contribute to the AAPI chapter on the upcoming CAP Journal of America's chapter on special populations and cultural psychiatry. And lastly, I am education chief as part of our child fellowship department, and part of that, my duties that I very much was excited to do is for each rotating group of third year medical students in psychiatry, I give them kind of a crash course lecture on cultural psychiatry and social determinants of mental health, because as I'm sure I'm preaching to the choir, this stuff is important for all providers, not just psychiatrists, and all of the med students found that actually really helpful no matter what field they end up going into. So here's just kind of a rundown of some of the lectures from last year that we gave that were mentioned in the evaluations from before. We had a grand round on cultural identity and anti-racism. We had lectures for child trainees on kind of specifics of migration stories, the importance of learning one's migration story, cultural competency versus cultural humility, the idea of culture versus race, which is a very important differentiation. A lot of these center on kind of AAPI or Asian American and Pacific Islander experience such as AAPI values, model minority myth, perpetual foreigner stereotype, specific cross-cultural challenges and important things to consider when working with AAPI populations, and things to keep in mind when conducting interviews and interventions with these populations, as well as a lecture on race and supervision, which was very valuable as well. This year, which is not on this list, as mentioned, Dr. Francis Liu gave a lecture on applying the cultural formulation interview to a Vietnamese man with bipolar illness, as well as a rundown of the DSM-5TR cultural formulation interview on cultural anti-racism changes and additions to that. We also had Dr. Kenneth Fung give a specific lecture on conducting psychotherapy with AAPI populations, and lastly, we just had Drs. Rona Hu and Steve Suss talk about Stanford CHIPAL, which is a community engagement program using skits and vignettes in theater to engage conversations with AAPI parents of teens to talk about communication and common themes of arguments and disagreements that come up, and they kind of work in the displacement of the theater to think about different ways to connect with each other. This is an example of a group flyer for one of our Crazy Stress Asians meetings. We often have a proposed topic. In this example, it's who am I, exploring our identity between the world's cultures and values and the impact on mental health. We held it monthly, virtually, because of COVID, and despite the fact that it was virtual and monthly, we had shockingly great turnouts and really a lot of vulnerability shared. And so this is kind of an example of what our flyers look like and kind of what people really found really important to have that safe space to talk about our heritage and our mental health. These are just some quick examples of kind of what are in some of the lectures that I've been given, and so there's an infographic on social determinants of mental health, cultural formulation interview, and on my specifically anti-Asian racism talks, you know, a history of anti-Asian racism and how it manifests today. And I know I'm out of time. Okay. Okay. Well, I'll spend a lot of time on all the positive feedback. So for the curriculum, as it was mentioned, a lot of people felt it really deepened understanding for AAPI experiences, and I think that what was helpful is because we can hone in on this population, we were able to go in more depth about it, and a lot of people found it really interesting because although we mostly see, I'd say, African American and white populations, when we do see people from an AAPI background, a lot of people feel really floundered, like flustered, like, I haven't had training in this. There's a lot of obstacles that come up that they don't feel prepared for, and so they found that this was really important and lacking in prior training, that it was really enhanced their personal and professional development on just cultural humility in general because you learn lessons from these kind of cases that you then strengthen your general ability to practice cultural humility, which you can then take on to other examples and cases where even if they aren't from an AAPI background. The affinity groups, like I said, participants really felt it was a valuable sense of community. In the context of BLM, a lot of the things we talked about was being afraid to ask if our trauma is valid as well. We don't want to step on the toes of such an important movement, but people really needed that safe space to find support and discuss racial issues specific to us and our history and how racism looks for Asian people, which is different, and so they really found valuable that kind of collective learning, collective healing, and collective empowerment through these groups. On the presentations, people really felt it was valuable to learn that AAPI is not a monolith. There's over 50 different countries and languages in Asia, and they really valued the kind of specifics that they learned about it and to kind of debunk some of those myths portrayed in media and in research and in literature, and they felt like it enhanced their awareness of their own implicit biases against Asian people and also general skills that informed their therapeutic engagement with all people. In terms of where we're headed, like it was mentioned, this is definitely going to continue to develop a formal social determinants of mental health curriculum for CAP trainees. We're going to have two new chief positions in the CHILD program for JEDI themes, which is really important for trainee engagement and investment. I think that is really valuable to see kind of like your peers doing this work and not just kind of passively taking in their information from the higher ups, and I think it's really important to put action, to put these words into action and really expand the engagement and application of these concepts in supervision and not have it be siloed in just lectures and curriculum and seeing it put into practice and having this be discussed on rounds every day. And so I hope that that's where we're headed. And thank you very much. So Dr. Gordon messed up. We have plenty of time for discussion. So I thought it would be a good idea to have Dr. Beeson come back and talk about some of the innovation we did in trying to engage, because as you know, we're in a COVID pandemic and we're using hybrid and virtual training, and that sort of became a challenge for us and how do we get people to feel comfortable and engage in these brave conversations when they don't really know each other, don't get to spend a lot of time with each other. And so I think that's really important that we talk about. The one thing that I think would be helpful for me in moving forward is really kind of getting a sense from you guys when we get a chance to talk about what your experience has been in building curriculum, if you've tried to do that. Because my experience has been, oh, you're black, you can talk about social determinants of mental health. Oh, you're Asian. So why don't you just see all the Asian people? Oh, you whatever. And that is challenging for me, because in this day and age, we understand that. I mean, Buffalo, New York just happened. I sat in a meeting in the Black Caucus meeting and just thought about all of us being here and grieving in our own collective way, but still having to hold our truth and talk about these conversations. And we know that this is real, but as we become more comfortable with it, I think it'd be easier for us to take the task. So all the concepts we came here, I want to make sure that it's clear, because sometimes I'm trying to be intentional and I don't always succeed. We did not think that a curriculum was the issue. We thought an infrastructure was the issue. Because there are many lectures that have been taught to individuals. They can Google this information, it's Google-able, right? But why aren't people applying what they hear and know in their communities? And the reason for that is that there needs to be an infrastructure to support the work, and it needs to be sustainable. And so although our curriculum is working and we're getting good response, we recognize that we may have to make some changes and make sure that the people who are teaching the curriculum have the support to continue to do the work. So I'm going to have Dr. Beeson come up, because I talked too much. Sorry, you guys, for rushing us, but we'll have a lot of time for questions and discussion. All right, so I'm going to go back, just have a couple of slides that I wanted to share about strategies to engage, what we did to engage fellows in the learning process. So it was really important that we set the tone for our fellows and really started off the conversation with what we call community connectors or icebreaker activities, where they could just respond to a question like, what do you do to be well, and what are you looking forward to, in a way to increase a sense of community and get people comfortable and warmed up with sharing and talking. And then also being really mindful of the fact that many people come to conversations about diversity, equity, inclusion, social determinants of mental health, experiencing some emotional discomfort, such as anxiety and fears and worries about saying the wrong thing or not saying the right thing. So we were very intentional about anchoring the conversation in, well, Courageous Conversations is a book written by Glenn Singleton that kind of provides this compass that you see in the middle of the screen that talks about the fact that people have a tendency to engage in conversations about race by leaning into their morality or ideas about what's right or wrong, that's one part of the compass, or by intellectualizing, that's another way that some folks engage in these conversations, or leaning into relationships or relational impacts, or by leaning into emotions. So people come to the table with different styles of relating to this content area, and it was our intention to normalize all of these styles while also gently encouraging folks to try to seek balance in engaging in content across all of these domains. And we also were very intentional at the onset of each seminar to have some shared agreements about how we will use the space and time to engage in conversations and learning together. Inviting everyone to stay engaged in the content, whether that means actively participating and responding to questions or asking questions, and sometimes that just looks like actively listening and hearing other folks share. We encourage folks to speak their truth and to experience discomfort. So allow yourself to experience discomfort to the extent that it's safe to do so, and also invited folks if they needed to take a break or to turn off their camera. When we were engaging on Zoom, in order to be well, we encouraged folks to do that. And then finally, expect and accept non-closure. These are all shared agreements from the book Courageous Conversations About Race. And this last one is really about the fact that we're not going to address these issues of oppression with one conversation or even one series of lectures, but it is still important for us to engage in this process together in order to foster incremental change over time. So some more engagement strategies. We like to integrate opportunities for silent reflection. So we would often incorporate kind of provocative reflection questions and gave people time after lifting up the question to think about it and share if they felt comfortable doing so. We also used anonymous discussion software. Sometimes people are not at a place where they're able to have open and honest conversations on these topics, but we didn't want that to prevent folks from engaging. So the use of anonymous discussion software like polls, for instance, and whiteboards were really helpful in those instances. And sometimes we saw more engagement when folks had an opportunity to share anonymously. We used small breakout group sessions. I think it was our first seminar we were able to do it in person, and I think a lot of people were experiencing anxiety because it was one of our first times meeting in person as a big group, and there wasn't a lot of conversation and engagement, and we transitioned to actually using Zoom and putting folks into breakout spaces so that they would have an opportunity to talk about these topics in a smaller space that may, that I believe, make some people feel more comfortable with sharing. And we sometimes integrated informal knowledge checks or quizzes that Dr. Gordon is really good about to support folks in the learning process and utilizing multimedia like videos and podcasts, et cetera, so that folks can respond to those. And then the last engagement practice that I think is so important in general, but especially when talking about issues of diversity, equity, and inclusion or anti-racism, is that we have a process for acknowledging microaggressions when they happen because they are going to happen, and that we use what I think it's learningforjustice.com calls call-ins versus call-outs or public shaming. And in order to do a call-in, this essentially involves using an incident of insensitivity, perhaps someone says something or uses language that's not inclusive, using that incident as an opportunity for everyone to learn and grow together. So we first want to ask for understanding about what the person meant by their language or their actions, and then clearly and directly state the harmfulness of that language or behavior, and then use your teaching skills to educate everyone on the history of that action or language and the connection to inequities, and then finally discuss and implement what is needed in order to repair harm in relationships. All right, that was the last part. So I think I'm so glad I had you come back because there were some things that I thought about as a program director but also as a supervisor for people in medication management and psychotherapy, oftentimes you have a little bit of sense of what their interactions may be like with patients and their encounters, right? Not necessarily you're in the room with them and you can see everything they do, but you listen to them, conceptualize, and give an oral formulation of how they're interacting with the patient. And I'm very intentional about saying, tell me what you saw. How did you experience what you saw? But also I am one of those program directors who will read your notes occasionally. One of my supervisees, and I consider her, she's an awesome fellow, she would say, Dr. Gordon, don't read my notes because I know what you're going to do. You're going to analyze it too. But she had a descriptor that was really troubling to me. And she put, it was a seven-year-old kid and he was aggressive with his mom and because of that, he got some, and he also got some trouble in school. And she used the word violence probably like three times in the note, right? Not aware that she used the word violence, right? And because I have this class and curriculum, I said, well, do me a favor. I want you to tell me why you put violence in a chart for a seven-year-old. Because in my opinion, seven-year-olds can't be violent. They can externalize, you know, behaviors, but I don't see them as violent in the sense that this kid doesn't have conduct disorder. And so I gave her an article to read and we talked about electronical medical records and descriptors and how we can engage in our own implicit biases when we're tired and frustrated and the patients are not doing well. But after that, asking her to read the journal, she expressed to me her discomfort. And this is a woman who, a woman of color, she expressed her discomfort in actually having a conversation with her colleagues around that. And so I thought it was a really good moment for me. And I expressed my discomfort back. I was like, I don't want to be this black woman that's telling another woman that happens to be black that you're racist, right? That's not what this is about. This is about being anti-racist. This is about putting things in our documentation and our treatment plans for all marginalized groups that help people see that this is a human being, right, one, but this is an individual who has a story. And their story is not based on all the, like, the things that kind of come to us because of our implicit biases that are unconscious. You know, we don't have much control over that. But we can gain more control over that by having these processes. So those are some of the things that's happened because of this, and there's been some challenges along the way. One other challenge, because I like to talk about challenges and next steps, and maybe I can go to that slide, if I can go back a little bit. Where am I? One of the challenges is, you know, how can I engage in this in a way that is not exhaustive, right? Because curriculum development is hard, you guys. I mean, you're up all night finding podcasts, finding articles to read, like, really trying to read this stuff yourself. And so you really want to, again, lean on all the resources that you have available. Another challenge is actually getting all of your trainings in the room together. I really think these curriculums do better when everybody's there, but we have a first year class and a second year class that's very busy. And so they're at different, multiple sites. And so this year, we were very intentional about engaging our first years more than our second years, and that felt not equitable at all. But I felt in a lot of ways, having that in your first year is really important, especially when you're starting to work in the community more. So that's just a little bit about what we did this year. I want to give you guys all the opportunity to ask us questions because we've got a lot of time. So if anybody wants to come up, thank you so much for coming, by the way. Hi, I'm Nicole Woods, and I'm a family medicine and psychiatry fourth year at the University of Iowa. And I'm also an APA SAMHSA fellow. And so my project was similar to Crystal, where basically Kevo and I created a Grand Round series, basically highlighting underrepresented minorities and LGBTQ mental health and things like that. Finding a space for it actually was challenging, but we ended up being able to do that. The question that I have is, with how taxing some of this work is, and kind of being that person because of the titles that we're given as residents, what were the ways that you did self-care? Which way to combat the exhaustion and those things like that? I think Tiffany and I all can ask the question our way, but I'll say, give myself permission to not be okay. I think sometimes we don't give ourselves permission to not be okay and foster this, I guess, environment where equity doesn't happen. Because people are not feeling comfortable to say, I'm not okay, and I need to be okay. And I do think that people who are more in a power position or a privilege position need to hear that and be able to receive that. Not that there's fragility that comes along with that. But I do think that it requires, you need to have a place that feels safe, right? So Crystal was lucky to have a program director who was interested in this topic that she can come to and be like, Dr. Gordon, I'm struggling right now with this. I mean, that didn't happen very often, but when it did happen, I think there was a place that you can go to. And I always am very intentional about saying, I'm not evaluating how good you are, I'm evaluating how hard you're trying. I'm not trying to say, you're not doing a good job. I'm not trying to say, you're not doing a good job. I'm not trying to say, you're not doing a good job. I'm not trying to say, you're not doing a good job. But in terms of your question, do you have people that was able to help champion you? I mean, I think when it comes to self-care, part of the thing is to sort of not only find people at your institution, but outside that are doing similar work and sharing and fellowshipping with them as well as a means to sort of really replenish, because it does take a lot out of you to do this. And I think we have a long way to go in terms of the collective responsibility for this. And so that's why you need to just sort of utilize your networks and really search these people out that are doing similar things. It feels isolating. And I really am an advocate for reaching outside of your institution as well. Thank you. I don't think I have much to add besides, for me, I think, Kim, you talked about, maybe earlier, you talked about how it's not really helpful to do these types of curriculums if there's not existing infrastructure to support the sustainability of it. And I think that's just one example of kind of like, you have to identify for yourself, what are the deal breakers and what are the things you need in order to engage? And sometimes the things, for me, I often kind of like, I have like my own process of figuring out kind of where I am and doing my own individual emotional check-in, if you will, about where I am. That's been really important for me in my process of doing this DEI work, because in my experience as a black woman doing this work, especially in conversations with folks who are more resistant to this type of learning and the importance of addressing health inequities, I am kind of like doing the work of teaching while also having to manage all of the emotions and the triggering that comes up as a black woman as I do the work. And so there are some days where I decide not to be the one who is kind of the champion voice, and I do that as in, it's self-preservation, right? Not just self-care, self-preservation is really important. So identifying for yourself what are the things you need and checking in with yourself, to asking yourself, is what I need in place right now and if not, giving yourself permission to not be that champion. Sure, thank you. Thank you. I have a two-part question, but first, thank you. This was very helpful. And even though we've been doing something similar, we did implement that Stony Brook DEI curriculum. I think what you have done is even further along. But as we think about what you've done, to two-part question, one is the DEI work often falls to minority. I mean, I've been joking at work that the only time the majority is not the majority is in the DEI committee. So how do we engage allies, right? So it seems like most people want to do the right thing, but then they also feel like they shouldn't be there. There is an awkwardness, right? So how are you engaging the majority in changing the culture because it would literally take everybody? And then the second part is, how are you thinking about how to know if this is making a difference, right? It's one thing, it can, I would imagine, stop at a very academic conversation, a thoughtful conversation, a sincere conversation, but how do we know it's actually changing us when we go out to practice, emergency rooms, inpatient, whatever we are, how are we actually changing ourselves, changing our practice, changing our interactions, as opposed to just a very stimulating intellectual conversation? Yeah, I think Dr. Ford has a chance to answer this question, but I would say, and I don't want to scare my fellows here, I think we need to ask our patients. Yeah. I mean, I think we need to ask the community, and that part of the party, like GME, is really trying to engage with community, but our patients have a voice, and they need to be able to say, this doctor just doesn't get me, right? And patients now can actually look at their medical records and really see what their provider is stating about them, and so one of the things that I want to do with my evaluation is have a 360 evaluation, and so I want to ask trainees to say, I want you to pick a couple of your patients randomly, and have them evaluate what their experience has been with you for the past two years while you're in the program. Now, some people may not feel comfortable with that, and I think that's really kind of thinking further along or more upstream, so to speak, but in terms of organizational climate change, we have an expert here on that. So, in terms of engaging people who typically aren't as active in the DEI space, the first thing is, like, you have to really go to the people that are in charge that really can propel changes in a department, so the first thing is that our chair came to me and sort of asked me to spearhead this, and when we were in conversation about it, what I said was, I'm not gonna spearhead this alone. Like, you and I are partners. So, we meet bi-weekly. When she needs to ask something of faculty, she does that. I don't do that. Like, I am not empowered to go to another faculty member and say, what are you doing when it comes to DEI? Why, why have you implemented this and not that? What is the conversation that you're having? So, I'm not powered to do that, and I think that's a mistake that happens at institutional levels, but here's our DEI person. They're going to come to you now with DEI codes and make sure that you're doing what you're supposed to do. But if we're not powered to do that, it's ineffective. It further leads to the burnout, which is why people don't stay in these positions. They become sort of title only, but if you have somebody like your chair who's at the division director meetings that I now go to to say, can you please tell me what is happening in this division when it comes to DEI, that's more impactful than you do it, and I think that's what people need to do, and then now people sort of like bring people in. You start to hear ideas. People will start to kind of like shake off some of their inhibition about talking about this because it's not me putting them on the spot. Are you racist? You haven't done this. Right, right, right. Thank you, very nice. Yeah, I just want to add that I have weekly meetings with my division director, and the first thing I said when I became the program director is I'm not doing any DEI stuff. You should have seen her face. She was like, oh my gosh, what is happening, Kim? What I meant was I can't stop my position as a program director, as a DEI person, right? I need to start my position as a program director, as a program director, and so you need to give me time to build those relationships with the people in my department and division, and you need to vet who you recruited to do the DEI work before I can do it, and so I think that's important, too, and those weekly conversations are courageous conversations. Sometimes it gets a little bit heated because Dr. Gordon will challenge people when I feel that I'm not getting what I need, but I think having the leadership from the chair and the chief of diversity made me feel comfortable coming into a position like this and really having these typical conversations. Sorry, what is your question? Oh, it's back. You've been waiting for a while. Sorry. Hi, I'm Kevo. I am a child analysis and psychiatry fellow at the University of Iowa. I'm also an APA Foundation diversity leadership fellow, and I serve as a co-chair of our department's diversity committee, so I'm really just edified and impressed by the development of the curriculum and in the intent and thoughtfulness of all of it. As part of my activities, I've also developed sort of a culture in psychiatry curriculum that ended up having to sort of also encapsulate a lot of these ideas of equity and social determinants and all of these other things, and I can speak firsthand about how exhausting that was, and you spoke about that, Dr. Gordon, about how tiring it is to learn about all of this stuff and then try to sort of manifest it in a way that other people can learn from it as well. I'm also highly impressed by Dr. Han's work and all the involvement that she had in it and kind of the list of the things that she's done with the curriculum. It just, like, exhausts me just reading about all of it, and it really seems like throughout the development of the curriculum, there was thoughtfulness in terms of how do we make sure there are faculty champions leading this work, but how do we also make sure that we're bringing up the residents and fellows in this to help them in their leadership and help grow them professionally, and also because their voice is needed in how we teach this stuff. And so I wanted to ask about how that intent was sort of weaved in through the creation of the curriculum, involvement of the residents and fellows, while also being mindful of the minority tax and making sure that they were protected from overburdening of having to do all of this stuff on top of the regular demands of their training. Krista, do you want to answer that, or do you want to share? Thank you so much for your comments. I definitely think that some of the minority tax thing was, like, self-imposed, because it's such an important topic, you know, for me personally, and it's definitely very tricky. I think being still part of the class as, like, a peer gives me some kind of weird kind of, like, in, in that, you know, we're also friends in my cohort, as well as peers who are kind of, like, subject to this curricula, and it was helpful that, to just have a good relationship with them, and I was, you know, suggesting to Dr. Gordon earlier, too, that I think that to kind of prevent it feeling like this is imposed onto people, to kind of, like, involve them as stakeholders, having more conversations with the trainees, and kind of getting a sense of where they're at in a way that is, not like a process group, but, like, more personal and intimate, to really see where we're at, what are some deficits, specifically, in, like, the audience we're working for. Like I said, so many people came from different adult programs with various levels of understanding of this stuff, and kind of really cultivating, like, curating a curriculum for who you're talking to, I think, is important, and just within my class, you know, I try not to be the DEI person, even though I think I'm seen as that, but I'm also just, like, a person, and, like, racism affects me, and, like, the stuff that's happened to, like, Asian people during COVID affects me, and I'm, it takes strength to be vulnerable about that, but I'm like, this is why I'm doing this curriculum, you know, this is why I'm doing these groups, and that makes a difference than just, like, DEI's in now, everyone has to sit through these lectures, type of thing. In terms of the minority task, I'm still learning how to say no, like I said. It's hard when you're a SAMHSA fellow, and you have this money, too, and you're like, I have to do stuff. So, it's still a journey for me in terms of that, but, like, not operating in a silo, I think is so important, and like Dr. Forrester said, finding people professionally and personally to kind of, like, recharge yourself has been so integral. And by the way, I've been doing Dr. Forrester's work for 20 years. I mean, before the SAMHSA Fellowship Program, we went to Xavier here in New Orleans. We wasn't friends or anything, we knew each other, but over the years, you'll meet, like, your tribe, and APA has a tribe, and so, like, leaning on them. So, don't sit, spend hours developing a new curriculum. Ask your peers and say, hey, what do you have? How can I use that, put my own little spin on it? We do that all the time, and I think that's really important to kind of think about, to share. But it's also true, we do need our allies to step up. Step up, people, okay? All of you, though. Thank you. I'm gonna do a paraphrase, sorry. Hi, my name is Dr. Chesa Crump. I'm a second year psych resident at University of Louisville, and I'm Louisville, Kentucky, and also will be applying for Child Adolescent Fellowships this summer. So, I'm excited for that. But I just have kind of a two-part question. So, my department has recently brought back our, for while inactive Diversity and Inclusion Committee. It was brought, kind of spearheaded by one of our faculty, who's a white woman, and was seeing that, you know, not only is our patient population becoming more diverse, but so is our incoming residents, you know? And what are we doing to help them? What are we doing to train them so that they're going to be prepared for meeting patients of different backgrounds, which I thought was amazing. And we had some of our first meetings, just kind of figuring out, you know, what are our core values gonna be? What are some of our initiatives that we wanna get started, whether they were short-term or long-term? The one thing I noticed is we had all these people from very diverse backgrounds, ethnicities, which was great, but it kind of came kind of like a competition, like everybody wants to be heard, everyone wants to be seen. It's like, oh, you're talking about black people. Oh, what about me, LBGTQ? Or what about me, immigrant? Or what about me, Asian? And it kind of led to us really not getting anything accomplished. So, I just kind of, just wanted, you know, wanted some advice to kind of have, create more of a culture and air of, you know, we're all in this together. Let's help each other be seen. Let's help each other, you know, get our points across and like, work on educating, you know, a more culturally humble, you know, department. And then my second part is, we have a lot of ambitions, but I think it's hard at this point with us just kind of becoming active on, do we have that infrastructure there to actually get started on a, you know, anti-race curriculum? Or is there some other pieces we have to work on before we even get to that point, you know? So, that's kind of my two-part question for you all. So, you should read the article by, I think it was Diana Jordan and a bunch of people that were part of it. But it was developing like an infrastructure kind of thing, like leadership and what was needed in terms of fiscal support and all of that, in addition to the APA learning center that Dr. Ford was in, talking about organizational climate change and what structures need to be in place. But I'll say, having been the president of the Caucus of Black Psychiatrists for the American Psychiatric Association here, we had the same dilemma where all the caucus MURs were fighting amongst each other around like, who's gonna be the group that's gonna be the lead of the conversation? And it was really challenging. Seven MUR groups, we all have diverse needs, interests, and who's gonna champion that? And I think in my leadership, the one thing that was important to me is the field buying and collaboration among, what is the shared consensus that we have as groups, right? What do we share in common? And make that the focus of our initiatives, right? So, I feel anti-racism applies to everybody, right? And so, I felt that if we centered that now, now, with that being said, I've had people say to me, anti-racism applies just to black people. I've heard that, it's crazy, right? But I thought it was important for me to say, we're gonna talk about anti-racism, but we're gonna talk about it this year around the AAPI population. Because we think that that's important and we have somebody who can champion that. But the other concept was culture and mutual humility. Those are key things that cross all of our intersectional identity. And so, it was really important to be intentional, like as a leadership group and say, hey, let's come together and let's talk about all the good things that we share in common. And not what we have different from each other. Because we have more in common than not. And I think that really requires some discussion even before you're engaged in any type of work. Because the thing that's been most harmful for DEI workers is having your peers, the people that you respect, people who you know get this stuff a little bit better and you're honest with each other. Like, no place is safe. I'm having problems with white people and all the people of color. Like, I feel good right now. And I've certainly had that experience, okay? So, be intentional and strategic and just know that because this has not been studied enough or it hasn't been centered enough in our study, we really need to look back into this more, colleagues. So, sociologists and psychologists and anthropologists and policy makers, it can't just come from psychiatrists because psychiatrists haven't been doing this well, okay? That's just the truth. I'm sorry. We have about four more minutes. Does anybody else have any questions or comments? Did I answer your other questions? Because I think you had two questions. The first one, yes. The second part, I think you mentioned the article at the beginning and I'm gonna have to come back and just write that down, so I'll come back. Okay, yes, all right. Hello. Hi. It's good to see you, Dolores. Dolores was my mentor and supervisor 32 years ago. And now everybody has a short morning to talk about the relationship. Yes. It's very good to see you guys. This is great that finally this is coming to the forefront. I have a comment and a question. I never worked in any hospital that did not have a mission and a vision. And in the mission and vision, I never found anything that contradicts the equal opportunity values, not addressing racism and this and that. However, in practicality, I'm quite old now and I have seen not following through the mission and the vision in most of the United States institutes. So my understanding is this forum was necessary, the DEI was necessary to augment that perhaps and bring it to the limelight and whatever happened in the country and has been happening globally. If you look at what's happening globally, it's almost like de-globalization, and almost kind of self-preservation and okay, let me leave first and then I'll think about others. The same sort of movement is going on currently in the United States and this was very much necessary. And supervising junior faculties and residents for many, many years. What I observed that as you mentioned that the white privilege and your mother did not participate in the white privilege and you did not participate in the white privilege. On the other hand, I have seen many psychiatrists being non-white participated in that privilege and became white privilege. A lot of Asian doctors became white privilege, okay? How do you undo that, number one? And how do you not only teach, teaching, anybody can give a lecture, big deal, five years into faculty, you can give a lecture and give your opinion. It's a higher calling, the ethics, the values, the morality, much higher calling, okay? How not to fall into that trap, okay? That you are trained in the inner city patients and the poor and the underserved. And the lowest, yes. And now you're going to a position where you're completely is going to forget them, okay? And these are the things that sometimes I think is kind of inborn, you have to have it and then you can do it, ratchet it up. And something is absolutely missing and you're not gonna be able to ratchet it up. How to identify that, okay? That you don't want to give effort to somebody that you know from the very beginning, this is a problem, we have it everywhere in the residence, fellows and faculty and everybody, okay? And how to hold them responsible at the end. So this is the time to hold people responsible, as you are saying, going to the division chiefs and saying, what are you doing? Questioning that, how do you keep it up? Thank you. You asked a really great question and a complicated question, so I'm gonna try to figure out how I can end and we don't have any more minutes, but let me answer this question because it's one that I am struggling with. So we first have to understand that the racial stratification in this country is based on white supremacy, right? And white supremacy has taught us that in order for you to be successful and succeed is that you have to engage in whiteness. And the closer you are in proximity to whiteness, the more successful you are. And so I don't know if I was like a kid and my mom said like, you need to be white to be successful, but I know when I was a kid when I went to school, oh, you talk like a white person. Oh, you articulate like this. Oh, you should go to the white schools. And then the idea was that white is right and everything else has to be white to be better, right? And so we engage in this deficit model even in our medicine and our psychiatry work because we're always thinking and comparing ourselves to whiteness. However, the reason why we're struggling is because white people don't compare themselves to whiteness. They compare themselves to being a human being and just doing their work, right? And so in our anti-racist curriculum, we really are trying to get there. We're not quite there. We're trying to talk about white fragility. We're trying to talk about white saviorism. We're talking about the color of protection because as we develop these systems and structures and systems of care, we recognize that it was coming from a predominant group's perspective and we didn't have enough buy-in from other people of color. So when I tell my IMG, for instance, people who are maybe descendants from Nigeria, I mean, they'll come into like a residency program. They have good intentions and I'm using them, for example, because that feels closer to home with my background. But they'll come in and they don't have the same worldview as African-American kids in the Baltimore City area. They don't. They just don't. And I can't judge them because they have a different worldview, but I say all the time that you have a social responsibility to understand your patient's worldview, right? And we all have a social responsibility for that reason. So I think it's a challenging question that you ask because we do need to have curriculum that addresses white supremacy. And I'm being a part of that thing and it's scary for me, you guys. I feel like, oh my gosh, I'm gonna lose my job with some of the stuff I'm saying. But I have two papers that's just out. If you Google me, that Rupi Legata, and I call her the blackest Indian woman I ever wanna be. She'll be here tomorrow. We are addressing abolition in medicine. We're talking about white supremacy. We're talking about food concepts because we also need to have evidence-based approaches to address this. So yeah, assimilation was the thing. That's why people did it. But now that we have leadership that's understanding this is important, I think that the Black Lives Matter movement and the other movement, anti-Asian movement and all of that, has helped us see that maybe we need to do this different. So I think you'll be giving us an answer. As in terms of supervising trainees, we have to be more comfortable with telling them what their implicit biases are. I think that's something that's always been a struggle because of the interpersonal part of it. You're like, oh, they're competent, they have the inventive knowledge, their patience is stable. So I'm the kind of programmer that's like, you gotta do something here. I don't know why you put that. And it's uncomfortable for me as much as it's for them, but I think that there's some growth in doing so. So I just wanna thank you for that question and thank you guys for sticking with us. There is a convocation with Soledad O'Brien and you guys know Soledad O'Brien did the Black in America and what is it called? I'm gonna look at it because I'm saying it wrong here. But I'm gonna be on stage a little bit with her, hopefully. But if I can't get on stage because I'm running late, I encourage you guys to go do listen to that because we need to actually revisit some of those conversations that we were having in 2015, 2016, and we kind of lost a little bit. So, thank you and I'll see you around. Thank you. Thank you.

development

evaluation

curriculum

social determinants of mental health

anti-racism

cultural psychiatry

diversity

equity

inclusion

implicit biases

mentorship

trainee involvement

DEI curriculum