We are winding down. This is the final session of the day. We made it. Okay, so I would like to introduce our final speaker slash moderator who will be helping us to manage our closeout activities and conversations. Please join me in welcoming Dr. Gabriel Escontrías Jr. to the podium. Dr. Escontrías Jr. is the Managing Director for the Division of Diversity and Health Equity at the American Psychiatric Association. Over the span of his 20-year career, he has served in various higher education and public health professional capacities with a commitment to increase diverse, inclusive, and equitable pipelines to post-secondary education, healthcare, and workforce opportunities. Welcome, Dr. Escontrías. Thank you, Madonna. Thank you. All right, Elvis already told me I have 10 minutes, so I'm ready to go. So I'm handing this magical mic to my first person right here. I know, that's the beauty of it. So if you are physically able to stand today, please stand, because we all have to remember, not everyone can something stand, so we should use language that's a little bit more inclusive. So if you're holding the mic, and everyone's gonna get the mic, so don't worry, we're just gonna pass it around. One word of how you feel right now. Just one word. Intrigued. Impressed. Excited. Inspired. Ooh, and I should say this, you can sit down once you say your word. No, thank you. Sorry, Seth. Involved. Motivated. Grateful. I guess inspired would say, so I'll say thankful to be here. I'll say transformed. Catastrophizing. Oh, the DDH team also gets to say a word, so Jordan, you're not off the hook. Very blessed. Inspired. Reinvigorated. Engaged. Energized. Impressed. Happy. Improved. I also feel motivated. Thankful. Informed. Time for. Engaged. Rejuvenated. I feel cool. Empowered. Driven. Encouraged. So hard to be the last one and try not to use the same word, but I feel motivated. But you're not the last one. Madonna is. So all the way up here. No, we need you on camera and then you can put the mic back. Relieved. Thank you, and it goes on the stand. All right, so thank you all so much for entertaining that quick little, even though you guys were all chit-chatting out there, so it's not like you really need to stretch your legs or anything, and I myself feel honored because just hearing everyone throughout the day, just hearing the presentations, hearing the feedback, clearly we have the right group of people in this room, not just because of all the knowledge that you bring, the expertise that you bring, but also because clearly you all lead with heart. And sometimes that's what we need. And I know when we kicked it off, I think what stood out the most to me was sometimes we do have to be a little bit honest with our actions that it is life or death. It may not be life or death for you right now, but it is for those individuals you're helping. If you're helping them get resources, if you're helping them get treatment, whatever small, big part that you think you have in someone's life, you are drastically going to change someone's life for better or for worse. And I know that feels like a very, like a tall order, like why did I take this on? Well, you did, we all do. It's what we were born into. We're born into that capacity and that ability and that wanting to actually do for others. I know sometimes it feels like people aren't doing for others and we all feel it and we think about it and sometimes we get a little bit negative about it or we get down on our luck about it, but the reality is I think everyone naturally wants to do good. If not, I at least can say the people in this room want to do good. So that I think is an honest statement. I can't generalize for everyone out there, but you all definitely do. So as Madonna was asking, can you close this out? Can you help us do something? I'm like, well, you want me to go ahead and put all this into one thing and then if I had let her read the whole thing, you would have known I worked in education for 20 years and I still teach a graduate level course. So what's the best way to do with individuals? Who's in the classroom? What's the best thing to do? Have you do the work. So Rezan and Jordan are gonna help me pass out some handouts. Do not turn to pages. Just stick to page one. So if you are in the first row, please turn around and this will be your group, these two tables. And then I'll ask Fatima if you'll be with this group. Then I'll ask Elvis if you can be with this group up here. And then if these two rows can turn around, these will be your group mates. So Megan, you'll be here. And then Rezan, when you're done, you'll be with this group and then there's a little hodgepodge of people here so we'll turn around. So you all are lucky and you get Dr. James and Jordan, you're over here. Perfect. All right. Everyone has a team, right? Oh, right here. Okay. No, because technically the last row is who you're with. Oh wait, no, I lied. You two do turn around. Sorry, I got thrown off by this row over here. You're all good now. All right, so what does the very top say of the page? Session one. Does everyone remember session one? All right, what's the first question? Yes, so the whole point of that question, believe it or not, it's very straightforward. Did you get what we thought we wanted you to get out of this? And if so, tell us how. So speak amongst yourselves. Take a few minutes first, maybe three minutes to jot down your own ideas and then you can share out with your group as you go for each of the sections. So the entire thing's only gonna take about, I'll give you 15 minutes max overall per page. And we are gonna break out, well, we're gonna come back as a collective and we're gonna report out. Everyone's not gonna speak. It's okay, because we're gonna get out of here well before 5 p.m., don't you worry. But yeah, go ahead and take three minutes and start with question one. Write your own ideas first and then talk about it as a group. Perfect. All right. How's everyone doing? All right, are you all? You can start talking with each other. You're all very quiet. You do know, once you get done with the whole exercise, you get to go home and enjoy your weekend. So now I'm the only one standing between you and leaving here versus earlier Dr. Wills and your food. So I'm not sure which is worse. Okay. All right. Yeah. Thank you. Thank you. Okay, as, how many of you have made it to the second question on the first page? That's okay, I see some of, some of your group have. So I'm definitely taking a look. Oh, no, no, no. Because it was the most fresh in your mind. So everyone go back to page one. If you've moved along. So the goal is that the first and second part of part of page one will actually help inform the third piece. So as you're talking with your group. Maybe there's some things you didn't think about that maybe you can implement, and then you can expand your list. I was trying to reduce any static by having three mics near me, but good to know. I think this will be... I'd like to go to the second one. Because I think... Because I think this is something that we're all trying to do. In case You know what's gonna happen All right, we'll take two minutes and then turn. Well, it's OK that you're hot, because what's going to happen is each group can volun-tell someone who is going to speak on behalf of your group. Two minutes. Any big transitions in life? I'll leave it here and you all decide who. 30 seconds. All right, we're going to come back together as one group for now. So we are going to start with what I'm going to call the Jordan Brown group over here, because that's how I'm going to remember names. So Jordan, who volunteered in your team? Well, we have. OK, it's on. Well, we have the presenter, so we have a limited group. I can go or Ricardo. It's me. What's the question? All right. So let's start with. Is there any obstacles? Let's talk about obstacles. Your group could have said no obstacles, but were there any obstacles you want to bring to the collective? Well, our group was talking about career development and actually youth training in mental health. And so the obstacle we were talking about was getting this information to younger audiences and not particularly cultural humility. But what does it look like to incorporate cultural humility training for like a young, young age group, not for physicians in general? OK. Any action items or steps that you all identified? Yeah, our conversation was a little off the rails. Yeah, well, our actual. So we actually were talking about the high school program that the APA has just started called the Aspiring Psychiatrist Program. And we were talking about how we're partnering with the Mary and Barry Youth Leadership Institute. And so that was where our conversation led. OK, so workforce. Yes, which is a good because what came out yesterday, some more numbers on how every ethnic group took a dip in medical school numbers. So very timely. Yeah. All right, Jordan. Who do you want to hand it to next? Let's go to Megan. Let's look for new voices we haven't heard from all day. That also excludes you. So you're reporting now. Give us some highlights of page one that you all discussed one. That's right. Yes. So when we were talking about the concepts of cultural humility in clinical practice, there was conversations around advocacy. I'm just going to synthesize that. And then also with regards to barriers, structural barriers, systemic barriers around what could prevent you from applying the concepts of cultural humility in clinical practice. And then for some action items, communication. I think where we hit a little bit of a different take on the communication part was around the lexicon and how that should be interpreted. And is there a heavier burden for individuals in health care to lean in versus pivot or retract in their DEI slash health equity acceptance, acceleration, amplification. So there was some positive tension around different opinions between the clinical team and the non clinician lawyer. So I said you need to lean in and not sort of not do the pivot because it's important to be able to understand the sensitivity to the community and the patients left behind. OK, that was a great summary. So thank you. Well, I guess you're all sending that to the AZA Fatima group. So who would like to go here? We were holding the mic. So our group, we were discussing in terms of the cultural humility piece, folks are mentioning that they're going to listen more to their patients. A big aspect of it is that I think in medical education and psychiatric care, the conversation historically was about cultural competence and realizing now it's really about humility and ongoing work. And we really cannot be competent of anyone's identity per se. And even if you share that same identity, the experience might be different for your patient. In terms of barriers to care, folks were talking about just like deliverables. We have such limited time seeing patients in the clinic. I mentioned that I work with veterans and some the culture with veteran populations is a little bit different than the more of the mainstream population. And then finally, in terms of action items, folks were talking about, again, like listening more, applying the cultural formulation interview. I think a lot of us have seen it in the DSM, but never really took a stab at going through the questions and actually implementing it with our patients. And yeah, that kind of summarizes what our group was discussing. That was a fine job. Thank you. Veteran Affairs, do you do anything with maternal mental health? Okay. Oh, Madonna, look right here. We have a panel coming up. We'll tell you more later. All right. And you can hand it to the next group, whoever you'd like. Whoever holds the mic gets to speak. Oh, hello. Hello. So the first question with regards to cultural humility, we all just kind of discussed how. Well, first and foremost, I can share a little bit about mine and how important self-reflection is. Knowing how I show up in, you know, in the space is what I'm carrying. And my other cohort were adding that, you know, the lifelong learning and being willing to, you know, respect the commitment to learning, but also to respect the space. I think that's what Dr. Lawson was saying, that, you know, respecting her client's space and, you know, kind of what they bring. I was nudging her on how humble she appears just in her regular, you know, encounters and engagement with her. The next one we talked a little bit about with regards to in our own practice and how we might, you know, utilize that. What I thought would hinder me in some ways was me not being aware of some of my own personal, you know, different things that I might carry that may be unresolved into a particular space. Time constraints, I think that was one of the ones that we came up with. Did you have one, Tina? And stress. Yes. Stress. And just, you know, day-to-day life stressors. And then action steps, we all kind of were in consensus with regards to assessments, the CFI assessment. And then Dr. Lawson mentioned that, you know, utilizing these assessments in our own organizations right away. Like how does this look, yes, you know, globally in a lot of ways or, you know, internationally, but in our own practice. Wonderful. Thank you so much. Oh, I need to give it to you. Yeah, you can have it to the next. I think. But who will be holding the mic? Oh, there we go. All right. So our group echoed a lot of what was shared already. For the session one, we, or the first question, we kind of said the same thing as the last, which is in implementing more of the CFI questions early on in treatment. And most of the barriers, you know, have already been covered, but time is a barrier, especially if this is not a longitudinal case, that often is a barrier. Fears and biases were brought up as well, which is an excellent point. Like the fear of the provider in going there with patients and asking these sensitive questions. And an excellent point was brought up about the expressiveness of patients. It's quite different patient to patient. Some patients are a little more guarded and need more rapport building in order to really trust providers, while other patients are a little bit more fluid and open. And action items, we said, you know, CFI interview, to ask, to discuss with supervisors, especially supervisors who already apply these concepts intrinsically and not supervisors who don't, and to hopefully teach our peers whatever we learned. Thank you. You can hold on to the mic. All right. So I'm feeling, and I'll use an I statement, as though I think you all got what was meant to be received from the first session. Fair to say? Was there any gaps? Anything that you thought you were going to hear and you did not hear about? Okay. All right. Fair enough. And now knowing how fast you all are, and maybe sometimes distracted, I can give you less time for the next page. So everyone can flip to page two. I'm going to have to sit Regina by Omar so that they can stay on task. So now you can take about three minutes and 20 seconds per section of page two. So start. That means you have 10 minutes. Thank you. Thank you. Thank you for watching! All right, we're all going to come together again, so I'm going to ask the Raison group to please go hand the mic to who you'd like to go first. As they're selecting who's going to go first, I think during that conversation someone brought up faith and spirituality, and well, now I'm just saying that because that's what we did on Saturday. So I can take a point of privilege while they're picking who's going to go next, because we went over to Philadelphia, and we partnered with the church, a non-profit from one of our SAMHSA MFP fellows, and we were able to host a very rich conversation in the community on the intersectionality of mental health, faith, and spirituality. And I think one of the most beautiful things about that was that we're coming in and having a conversation with the community, not at the community, and they were able to ask questions, they got to hear directly from a variety of psychiatrists and also therapists, and really get a feel for what should you be asking. And some people had burning questions that maybe they felt intimidated to ask before. So it was just a great, I think about three hours with them that we got to spend, at least, before the snow hit. So, all right, raison group, did you pick who's going next from another group? You went last, so you don't have to go first. So you can go hand the mic to someone. Oh! Dr. Lawson-Thaw, I'm moving along. Okay, so, navigating cultural intersectionality. So we had a little brief review around intersectionality at this table. So one of the things was open-ended questions, allowing the patient to speak. We think there is a lot of value in listening. Connecting beyond language was one other thing. For me, being a clinician, I talked about ableism. I'm thinking about things such as the disabled, right? What is that interaction like? Because much of the environment, the built environment, speaks to them, right? And that's a respect issue. Even things such as deaf, deafness, right? Having individuals who are deaf, so it may not necessarily be about language, but making sure you have folks who can sign, you know? I hire signers to come into the space to be available for these people, and not always relying on family. And then, it was what you said, I can't read my writing, my handwriting is really bad. Looking to learn and understand. Did I get it right? Looking to learn and understand. Do you want me to go to the second one? Oh, sure. Is that okay? I'm just going to keep moving. The mic is yours. So, what would prevent us from adapting our communication style to effectively engage with those from diverse backgrounds? I think unanimously, we felt nothing, right? And we want our clients to be comfortable. We want them to be well-equipped to receive the knowledge and the information that we're giving them. You know, I acknowledge, you know, it could be a diagnosis you're receiving that day, it could be medications you're receiving that day, it could be medication instructions, things about side effects, things you can and cannot do. So, lots of material information that you have to process. So, we want to make sure that folks are well-equipped to have a reference. And then, we talked about misinterpretation. And sometimes it's not, it could be the same language or you understand the language or they could speak English, but it could be thick accents. So, you still could have, right, communication gaps just because of that. And then, lastly, action items or steps that spoke out today, perception, utilizing and sharing resources to assist our clients in navigating their various identities. Again, speaking back to intersectionality and how do you help people resolve some of those identities with support and resources. Is that anything else you want to add? And also, how you contextualize asking the questions. Oftentimes, we ask questions and we get the response to the questions, but it may not necessarily be the question we meant to ask. And the folks that we're asking the questions to may not necessarily know how to process what's being asked of them. So, being really, taking a posture of humility to really think about and reflect on how we ask the question to make sure that we are receiving the response that we need in order to be able to best support the client. Is that okay? Wonderful. Okay. All right. Y'all can hand it to the next, oh, oh, oh, oh, oh, oh, thank you so much. So, for the first question, we talked about just building rapport with your clients from the beginning and creating a space where we're identifying just their basic necessities. So, in my practice, when I see clients in person, it's just starting with, would you like some water? Or do you need to use the restroom? Like, just starting taking care of their bio needs first. And then, if there is room and space for self-disclosure and recognizing that we're also starting at this place with the tip of the iceberg. And so, asking questions that will get to kind of like what else is under there, right? And so, sometimes even just acknowledging what we see and also asking clients or patients if there's anything they want to learn about you. I think it goes, it's bi-directional. And so, for me in my practice as a reproductive psychotherapist, folks always want to know, like, do you have children of your own? Or have you breastfed before? And so, those are things that I feel like it's important for them to know so that they can trust me in the work that I'm doing. What will prevent you from adapting your communication style to effectively engage? I think we didn't really talk about what would prevent us. But I think not being aware of your own biases, not understanding what you're bringing to the table or into the space will really prevent you from being able to engage. And then, I don't know if anyone wants to help with the action steps from the group. No? The self-disclosure piece. So, some folks haven't been doing the self-disclosure piece. Perfect. Thank you so much. You can pick who you'd like to go next. From another group, not from your own group. Oh, wonderful. There we go. Oh, you're holding the mic. Okay. I think I'll probably be able to answer the first one. I'll pass the mic to someone else for the second one. So, my thought about the first one was that there's actually, like, something mentioned about this earlier, but I couldn't remember. But what I thought was also kind of, like, echoed in the first group that trying to understand the patient's perspective before venturing out to, like, engage them is very important. Because when in a very charged environment and time, you don't know what's people's background, what's on their mind, what they want to hear and what they don't want to hear. So, trying to, like, understand them, understand their background, their perspective before engaging them will be very, very important to, like, communicate whatever you need to communicate with them. Thank you. I can do the second one. What would prevent you from adapting your communication style to effectively engage with clients from diverse backgrounds? I wrote down being in a hurry, having a high volume of patients. I, some of the other people here said being overly rigid with your approach. And the other one said not making enough effort to understand the patient. Thank you. And action items. Who's going to help you with that? Oh, there you go. Well, yeah, one of them that we wrote down that we agreed on was Z codes. But I think as far as learning, I think these are all skills that we're talking about, right? Open-ended questions. And every time open-ended questions come up, I think about motivational interviewing. And it's got a really great set of principles that include, like, affirmations, reflections, and summarizing what the patient said to demonstrate that you were listening to them. And also to test your understanding, you know? And this just requires some supervision. So maybe finding someone who can help us learn these skills. I think that would be an excellent action item to add to that as well. Perfect. Yeah. You can pick the next group. You have the Jordan group or the Raison group? Oh, there you go. Thank you. Thank you. I guess I'll... So I think it's interesting to have our table of non-clinicians. So I think the discussion was very great. As it relates to the question of communication effectively, we talked about being more sincere about understanding historical and linguistic perspective, right? That's what you wrote, right? Linguistic perspective of our clients or our population that we serve. Because I work with young people. And so that was one of the things. And it speaks to becoming more cultural, not just culturally sensitive, but culturally informed about the history. I shared with the group that at one point in our organization, we did an accounting of the various nationalities represented in my program. And we had 31 nationalities. And so it is important, one, for people to learn about each other. You do more concerted efforts to have a historical teaching, cultural understanding, and exchange of information. But we also got into a deep discussion about really finding out... And Neil really hammered this notion about finding out about what makes our people tick. Like, what do you feel about certain circumstances in life, whether or not it's being, you know, what's going on politically? What's going on about truth? What's going on about intimacies? How do you really feel about that beyond just asking the question, what's wrong? What's your concern? So I think building a greater rapport means, one, becoming more in tune with your individual in front of you through learning those dynamics. And I would dare to say that the group also... One of the things I've learned, and I'll add this as personal privilege, since I have the mic, I don't know if the group would contend with this, but oftentimes I find when I share myself and who I am and my history and experiences with people, and they're like, oh, I wouldn't have never believed that about you. It opens them up tremendously. And so that's one of the things. Did I cover everything in one? Wonderful. So you want to... So we did not address number two. And I like the first section that said we didn't cover that. And I think we got it. We sort of consensus that we don't approach things from what we can't do because we... I mean, this is my liberty again. I think you all are miracle workers and you all are super humans, right? And I think when we think about working without in our practices, whether or not it's mental health, I do youth leadership training and development, you have to be willing to know that you can overcome anything. So the universe works like it's supposed to and we're going to win. But in the third action item, we spoke about one, mandates around language communication. For example, in DC, I know I work for the DC government, it is mandatory and you can request translations for everything, particularly in eight languages, Mandarin, Spanish, Amharic, and other languages. So I think that across the board, the medical industries and the association can push whether or not they can mandate it or create incentives around making sure that the language barriers are broken through translations of all communications. And then, I think we kind of talked about it, or maybe I added this just in a note, do regular lessons of... Okay, I mentioned that. The lessons around learning more about cultural communities and it's kind of like when you were a kid in school, they would do Latin American Day or whatever. We do those trainings specifically. Anybody else want to add? Did I miss? All right, last group. So... Oh, no, over here. Oh, it's right here. Oh, that's right. You all were last. He said, I can give it to somebody. I know you... If you want to pass it to us, you can. All right. All right, so for the first question, how will you adapt your communication style to effectively engage with clients from diverse backgrounds? We talked about being comfortable with different communication styles and using the patient's own language to start the conversation. So instead of giving them the topic to talk about, let them bring it up first and just use their own quotes and their own words. And then body language as well is really important. And you can model that or reflect whatever the patient is showing you. And then for the next question, what would prevent you from adapting your communication style to effectively engage with clients from diverse backgrounds? We talked about language barriers as well. And the patient not understanding and being too scared to ask certain things. So perhaps giving them more time to get to know you and build rapport before asking and diving deeper. And then last in that group, we talked about addressing generational differences as well. For the last question, action steps and items, we talked about using technology like AI and translators during interviews if patients are OK with that. And then also, that would help us basically summarize what we talk about and adapt better. Yeah, be more present in the conversation. Perfect. And then last, making sure that if you don't understand, as a provider, you ask open-ended questions. Wonderful. Thank you. All right. I think you all got what you needed out of session two. Last page, because it's fresh on your mind, five minutes. Because it's fresh on your mind, five minutes. And I should get no face, no looks from this group because you have both speakers or had both speakers. You still have one speaker, so that's easy for you. All right. Let's take five minutes, and then we'll wrap it up with the last comments. And I get to send you all home so you can have a restful, hopefully not too cold of a weekend. One minute. Tired? Yeah, it's been a long day. Thirty seconds. And I know. Yeah. Yeah, yeah. But I don't have to. That's what I'm gonna say. All right, here we go. So the fun part is I'll be handing the mic this time. So the main thing our group mentioned for the first one was to really utilize a social determinants of health framework to adequately contextualize a person's experience in order to provide culturally-related appropriate care that is sustainable and provides longevity for the patient. For the second piece, what did we say, for the second piece, for the bias? Yeah, so for the second one, we considered biases and just ensuring that we're culturally aware of those that we are serving. And for the third one, they all kind of tie into one another. Self-awareness, ongoing commitment to training and education to ensure that one is integrating all of those competencies into care. Gracias. All right, Azza. Well, I mean, in terms of how to incorporate equity lens into your mental health service delivery is partly is to try to put yourself, ally yourself with organizations where that's a fundamental value. There are many, there are, and there are many where it isn't, particularly if they're population-based rather than, I mean, if they're like, you're dealing with women, then within the women's space there's going to be equity issues or if you're dealing with vets. But as opposed to, you know, this is just a clinic that sees people with a certain insurance. I am fortunate, personally, because I'm so much in retirement that I can structure my own time and so that I'm allowed to, you know, I just don't bill for every minute that I spend with people. I spend longer if I need to because I just can't speed up my pace. Other than that, we were talking, though, about how people appreciated the involving patients in the design of and implementation of research and research questions, that that was kind of a new idea that was very appealing. Why it's hard to do this, I'm not, we didn't really get into that in great detail. Although, again, if you're in a, you know, in a capitalist system where the money organizes the resources, that's a big problem. And also, I think, we didn't talk about it, but, you know, patients appreciate, a lot of times people feel condescended to. They want to simply be treated as they are and not necessarily emphasizing that they have disadvantages or otherness or something that you don't have. I mean, part of the professional space is to ignore these questions as long as they don't get in the way of treatment, but that's, we didn't talk about that. Action items, I don't, anybody got any? I see one in front of you, an action item list. Did you change the paper? I could have sworn there was one there. We have language adaptation, so everybody, for example, you can have material in English, but our patients speak Spanish, Mandarin, so we have to adapt that. And also, give some, incentivize patients for participation and our research projects could also be helpful. Thank you. Look at that. Teamwork makes the what? Dreamwork. There you go. Megan. I'm in private practice, so my answers were reflective of the ecosystem I'm in and also my cultural presentation personally. When I think about incorporating an equity lens, I think about overall orienting my effort towards those with greater needs. So just kind of titrate things. Favor people that I sense are coming from cultural disadvantage, so look for markers when I'm looking at, I mean, I'm not always open for new clients, and so when I have choices, I try to favor folks who are more likely to have a difficulty finding care, implementing a sliding scale. When it comes to, continue to the second one on this page as well. When it comes to thinking about what would prevent, what would get in the way, I had a very privileged patient of mine just contribute funds, just wrote me a check and said, set this aside and offer discounts to people who need it. I don't need it. And so I had that opportunity to use that. At other times, I ask myself, should I charge just up front, charge more privileged clients more and apply those discounts? And it puts me in an interesting role in terms of redistribution, and so I think that would be a question. Would it prevent me? I don't know, but I think about that sometimes. And it seems to me one barrier for equity is just the fees I charge. So how willing am I to cut my fees, reduce my own salary? Thank you. Anyone else want to, from this group, want to? All right. Is anyone in here, do you currently work in a practice where they have a sliding scale? Oh, okay. I have this perinatal clinic which has a very low sliding scale because it's mainly staffed by residents. But sometimes we get very privileged people who use our service because we try to make it so readily available, and they need it when they're pregnant and we're the only people that the obstetricians know to refer to, and so I get these, sometimes we get people on Medicaid and sometimes we get lawyers at the very high level in the government. And I don't know, because we charge a flat fee or nothing for everyone, but I'm wondering whether that makes sense. I mean, we should probably charge the privileged people. We could, but we should, but we shouldn't, because, you know, if a psychiatric problem is a psychiatric problem, your need is for help. Thank you. And we'll pass it to the left. Your left. Thank you. Yeah, I've used the equity sliding scale, and I can pull it up, but there's definitions that come, right? And it allows people to identify where they fit in within that scale, and on this honor system of, if I meet these criteria, then I can pay this. And so I've used that before. Thank you. All right, two more groups. Raise on. Con quien? Contigo? Not contigo? So for our group, for the first question, we talked about using the CFI, open-ended questions, working with social workers, and basically incorporating the patient's experience and backgrounds into our delivery of care, and also providing language-concordant care to the best of our ability, even if that means just discharge summaries or like patient information or in a language the patient can understand and engage with. For the second question, we talked about systemic and institutional barriers and pushback, because these inequities and disparities exist because they benefit people in power. Otherwise, they would have been addressed already. So just knowing that not everyone's on the same page, and there will be pushback and people who don't necessarily support efforts to incorporate an equity lens into care. And also considering that there are time constraints, and everyone's bringing their own biases to care in the conversation, whether or not they're aware of it. And for action items, we really resonated with that lived experience map and incorporating the patient's experiences into care and making sure that we're seeing and including their personhood in order to provide quality care. Thank you so much. All right, Jordan, wrap it up. Ricardo? So I think our conversation was kind of balancing between two things, which is I think started at kind of looking at the system that you're practicing in, and then taking into consideration what you bring to that situation, and then reflecting on yourself and what can you bring to the system that you're working in or want to work in. Because I think we realize there's different spheres of influence, and that based on where you are is going to depend on what you kind of bring to it. So I think there was some mention around people working in an autonomous situation where they do get to kind of decide who they work with and finding those organizations you want to ally with. But I guess another perspective could be like finding those areas where you do feel that conversation needs to happen to impact disparities, truly. And then understanding based on who you are and what your reflection is on, what can you bring, and then where are you going to bring that? So that's what really resonated for me, and I think while we're kind of preaching to the choir here, because Neil made a good point, and what prevents us from doing anything is kind of everyone's kind of on board of like, we're not going to let anything prevent us. Everything's going to be outside of us. I do think there's something to be said that by being here in this group, we're gaining the tools and the language. We talk about language, but a different type of language, like how do we talk about these things and what groups, whatever it's. This group is focused on data. This group is focused on human emotion. This group might be impacted by right and wrong and good and evil, but it's like we're kind of getting... When I say transformed, we had that one word to pick, I picked transformed because I'm picking up all these tools of how we talk about this in the different spheres that we have to interact with or choose to interact with to kind of create, hopefully, transformation, hopefully progress towards addressing the disparities that we know exist. So does that cover? Is that okay? Wonderful. All right. So on behalf of the American Psychiatric Association, on behalf of Dr. James, who had to run and take a meeting, and also on behalf of our entire division, the Division of Diversity and Health Equity, we appreciate all the speakers that joined us. We appreciate you all for spending the day with us. In addition to that, a huge thank you to AHRQ, who gave us a grant to put this on, and a special round of applause to Madonna in the back for really spearheading the entire project. So here's a little cheat sheet for you. Everything you did right now is going to be part of your evaluation. So when you get the evaluation from Madonna, you've already done most of the work. So you already have all the ideas of everything you're going to write. Do give us honest feedback, because I enjoyed hearing everything you were saying, because part of what we do within our division, we produce new courses for CME, both for the membership at large, in addition to our lead institute that's just for the SAMHSA fellows. In addition to that, we host a variety of webinars and community events. So hearing what you're saying tells us how to move forward. There are some things that thankfully we're already making a lot of progress on, like the workforce piece. We now go all the way where Jordan's about to launch the high school component. We have a two-year program, a four-year program, a medical student program, and a resident program. So we're definitely trying to still continue doing work. And even though we've had the grant for 50 years, clearly there's a lot more work ahead of us. So we appreciate you for being here. We appreciate your time. We appreciate your talents. And please know this won't be the last time you see us. And do reach out to us in any way or capacity that we can continue working together. So thank you, everyone, for being here. If you parked in the structure, see me, and I can give you a ticket validation. That way you don't pay for parking.

Dr. Gabriel Escontrías Jr.

American Psychiatric Association

diversity

inclusion

equitable opportunities

cultural humility

intersectionality

mental health services

systemic barriers

culturally competent care

social determinants of health