Thank you all. We're gonna get started with the second session. If I can get your attention. All right. So I would like to introduce the first speaker for the second session. Dr. Javid Shakira is the Chair of Psychiatry at the Institute of Living and Chief of the Department of Psychiatry at Hartford Hospital. He is the founding director of Hartford Hospital's Center of Research on Racial Trauma and Community Healing. Dr. Shakira is an internationally recognized health professions education researcher and thought leader. His research program explores novel approaches to addressing stigma and bias among health professional. And he has also been involved in advocacy and cross-sectoral work in education, policing and community services. Thank you so much. Join me in welcoming Dr. Shakira to the podium. Thank you. Thank you so much for having me. Thank you so much to all the incredible people that spoke this morning. It's amazing how APA has curated our group because I think successively each and every presentation actually leads up to and builds upon the other. So I hope I can honor the voices in this room and continue that trend. So to start, to tell you a little bit about me, because actually the bio in the book was a bit of a typo. And if you're wondering, I do still have that sweater. So I am the child of immigrants from Pakistan to Canada. I grew up in greater Toronto. I lived and traveled throughout the world, including doing my residency and fellowship training in the U.S. during a sociohistorical period. It was very different than this. I am a permanent resident of the United States. I just became a permanent resident three weeks ago. I was a visa holder. But much of my childhood was marked by growing up in the shadow of well-educated parents who experienced discrimination in the workplace and who internalized that discrimination to question their worth. So through all these trials and journeys, I found myself a practicing child and adolescent psychiatrist back in Canada, early in my career, with a lot of interest in the topics we're talking about today, but bearing witness to the fact that one of the biggest forms of discrimination is the dehumanizing way we treat the people we serve in acute health care settings. And when we leaned into it, we found that it's clear that there's labeling that leads to avoidance, but helplessness and frustration with well-intentioned people who are working in a system that was designed to be prejudicial and discriminatory in a cycle that keeps spinning. What started as a master's in education thesis turned into a PhD in education. But part of why I was prompted to do that work is because I have an inner social scientist like many and like Neil was saying, but part of why I did it was because I felt like the ways in which we have conversations about these topics is fundamentally flawed. It's built on a paradigm that there's a good group of us that get it and a bad group of us that don't. And so our objectives are to round up the bad group and put them in an implicit bias training module. But of course that's ridiculous because it leads us to spend all of our energy pointing fingers and I thought to myself, what happens if we start this process by looking in the mirror, holding up the mirror to ourselves and our systems? So a lot of the research that I did in my PhD looked at how we have feedback conversations with health professionals about our role in discriminatory harm. This was one of our first studies and I must say this study changed me personally and professionally. Through my own lived experiences, I always believed that the North Star was humanizing one another, seeing each other beyond stereotypes. But in this study, when we held up the mirror to health professionals and said, despite your best intentions, you're going to be part of harm, they said, well, that's impossible because I am a professional and professionals are neutral and objective. But of course it's possible because I'm a human being too and of course I have bias. Why I was struck by this is because there's something about health education, medical education that actually teaches us to dehumanize ourselves, to compartmentalize our identities as a form of self-protection. And so I thought, you know, if humanization is the answer and there's something about how we train ourselves that actually teaches us to dehumanize ourselves, then we've got something deeper we need to contend with. My work questioned assumptions about cultures of perfectionism and toxicity and the model that came out of it highlighted that we need to frame initiatives, interventions, modules, and training around the ideal that was echoed earlier this morning. We strive for the best version and we accept and embrace that we will stumble, but that we're not afraid of stumbling. We hold up the mirror, create cultures where we cultivate feedback, have contextually relevant reflection on our role, but then we actually set goals and make change. And our research found that the secret sauce was sharing and dialogue with peers. We cannot and are not meant to do it alone. In settings where people were able to openly talk with one another about their flaws, interventions to address bias and improve cultural congruency worked. In settings that weren't the case, where people didn't learn in teams and work in teams, they did not. But I'm not just here because I published a bunch of papers. And I knew that the audio wasn't going to work. So what I'll do is, I'm not going to do a voiceover, but I am going to tell you the story. Let me begin by saying, of course, that we are all so deeply sorry for what your community is going through and how you've been forced to deal with this tragedy. I wonder, with the people that you're speaking with and in your role, what is the conversation like right now? It's tough. It's unfathomable. I think for me personally, our family had a personal connection to the deceased, which takes this to a whole other level. The kinds of conversations I have to have with my young children, but also the conversations we're having as a community. I think there's an outpouring of love and support and solidarity, which is great. But I wish to remind my friends and neighbors to not look away from the hate that contributed to this incident. So on the evening of Sunday, June 6, 2021, family, friends of mine, three generations decided to have the audacity to go for a walk in London, Ontario, Canada, where I used to live. And a white supremacist driving a black pickup truck, who was driving around looking for people who look like Muslims to kill, to send them a message that they do not belong, murdered them by running them over, killing four out of five of them. Not too far from my home. I had to have conversations with my children about why their friends and the kids that they grew up playing with were murdered. So I am not here because this is about an academic exercise. I and we are here collectively to shatter the illusion that we are any different because we work in systems that care for others than those we serve. We are just as vulnerable to the wounds of identity-based trauma, discrimination, mistrust and harm as anyone else. We know, even though we in psychiatry have denied this, that oppression and discrimination can be conceptualized as forms of toxic stress that have clear empirical scientific consequences. But what we also know that if we want to address this, we have to look at ourselves. Because the toxic stress leads many of us, including by virtue of working in a field like psychiatry that is structurally discriminated against, to experience the burden to undo stereotypes, the pressure to overcompensate, and a consistent experience of gaslighting and toxic positivity, even on a national stage. So I don't have time to get into all of this, and I really want us to think about dialogue in our session, but I do want to share with you how I'm approaching this now in my role as a chair, as someone who's trying to advance this work, working within systems to make radical change. And what it requires us to do is shift away from a system of care that merely treats symptoms, a system focused on coping, towards a system that embraces the wholeness of true healing. As Dr. Resmaa Menachem says, clean pain is the pain that mends and can build our capacity for growth. Dirty pain is the pain of avoidance, blame, and denial. When people respond from their most wounded parts, become cruel or violent or physically or emotionally run away, they experience dirty pain. Dirty pain, folks, is so magnetic and alluring. It's the pain of doom-scrolling, looking for something that tells us that we matter, that we are seen. Healing requires us to spend time with clean pain, the pain of transcendence, the pain that reminds us that our worth will never be determined by an election or speech. So what we're trying to implement is something we're calling healing-centered pedagogy, and it's built upon the incredible work primarily coming from Afrocentric psychology, liberation psychology, many black and brown women, intersectional feminists, who have helped teach me and created and fostered a way of thinking. Healing-centered pedagogy isn't trauma-informed, it isn't a performative buzzword that becomes a means for corporate consultants to generate income. Being healing-centered is about embedding critical reflection, holding up that mirror to ourselves and our systems, recognizing that we were never meant to do it alone, and embracing collectivism rather than individual-centric approaches. But what I'm going to lean into for a few moments is this idea of cultural authenticity and self-knowledge. But I want to add, moving a system towards healing requires that we anchor ourselves to narratives of hope and strength. It's not about the problem. The racially minoritized patient isn't the problem. They bring strength and grace and light. We need to fundamentally remember that this work is the work of generations, and that the unwavering ideal that is part of the conversation is the ways in which hope must be cultivated and maintained, and strength is intrinsic. So I said I'm going to lean in a bit to cultural authenticity and self-knowledge. What this speaks to, particularly in the educational literature, is the idea that as we shift away from performative DEI that lumps people into categories and demographics and checks boxes, we need to redevelop and radically reconceptualize how we understand minoritization. Two brown men have two entirely different experiences of their relationship with their identity. You cannot assume that both represent the same thing, just as we would not assume as part of how whiteness works that two white men would represent the same thing. For us working in the system to navigate intersectionality, we need to spend time with our own wounds. We need to understand our own relationships with the most wounded parts, and how to develop healthy, more adaptive ways of being and knowing ourselves. So here I am, recruited from Canada to this country, to try to make this change at a place called the Institute of Living, which if you didn't know, was one of the first mental health centers in the country. Two hundred years ago, the Institute of Living was found in a very liberatory ideal that people who suffer from mental illness do not deserve chains or cages, they deserve dignity and freedom. Yet they thought someone crazy like me was worth recruiting. So what we're doing is challenging the fact that we may have strayed from those liberatory ideals in psychiatric care, primarily due to our normalization of coercive harm, carceral systems, involuntary detention, and restraint and seclusion, over prescription of metabolically offensive antipsychotics. We have co-designed a vision with our community partners, communities that we partner with, that we're calling Radical Recovery. The recovery movement has helped us understand the power of lived and living experience, but it's not moving us far enough. So we are deliberate to add the word radical and work under the themes of integration, liberation, and innovation to do whatever we can to transform things. But for me personally in my role, as I try to integrate restorative ideals into a system that hasn't been designed or calibrated with those in mind, I have to consistently practice space and grace. I have to go to work as a leader in a department knowing that racism is killing people every day in the hospital in which I work, and not be distracted by that to hijack my ability to make change. But something else that I've leaned into, both personally and also intellectually as we're doing a lot more research on this, is when we look at a system where we want to increase voices of lived and living experience, what we realize is that our norms on self-disclosure also need to be rethought. Self-disclosure and therapeutic self-disclosure as a construct was taught at a time when everybody looked the same. Some of us, by virtue of how we look, are intrinsically disclosing. Some of us who advocate that people can Google are disclosing. But at the same time, we must de-center ourselves in encounters without dehumanizing ourselves. We always center the patient. We always center their needs. Yet, the business literature tells us we need to be vulnerable, have the courage to be vulnerable. But, of course, vulnerability is gendered and racialized. It is not the same for everyone. Much of what we're seeing in implementation is really a tightrope, a tightrope between credibility and vulnerability. What we know is that vulnerability can only happen under certain conditions. There has to be trust, safety, inclusive leadership. You have to be part of a healthy team. If it's a toxic team full of ego and territorialism, vulnerability won't happen. And, of course, you need structural supports. You need sustained structural investments in making the system work. But what I want you to zoom on is the idea of clear communication and boundaries. And this speaks to one of the questions earlier. We are obsessed with a culture of niceness. We forget that radical kindness and radical love means actually setting limits and being real and keeping it real because we're all part of one another's community. So we should not fear the limits of what we can and cannot do. That's the way the world works. Sometimes this work is the art of the possible. All we can do is show up every day, do the very best we can, and hold ourselves accountable and be role models for the kind of change that we seek. But like I said, we were never meant to do any of this work alone. Without community, there is no liberation. But community must not mean a shedding of our differences nor the pathetic pretense that these differences do not exist. Putting it all together and thinking about where we need to go to be more attuned to those we serve and to build and transform structures, systems, we need to shift from a system of superficial coping to a system of healing. We need to move away from the idea that there's a dialectic or a zero sum, that the individual is made up in parts or categories, or that psychiatric care is the be-all and end-all of well-being or distress. And in our systems and our ways of being within organizations, we need to embrace subjectivity and collectivism. We need to embrace mechanisms and approaches and methodologies of co-design and co-production. We need to remember that power and dignity is not a pie where you give and you lose or you seed or you gain. Power is something that is fundamentally meant to be shared. And ultimately, we need to remember that experience and expertise go hand-in-hand in order to move healing forward. So I asked a couple questions implicitly here. I said, you know, why am I here? Why are we here? Where do we go from here? And I want to pause as I conclude and invite you to take a moment and reflect on your wounds, to honor them and affirm them, and remember that you are also wired with the intrinsic capacity to heal. Thank you very much. Thank you so much, Dr. Siqueira. Let me introduce our second speaker for this session, Dr. Liliane Comas-Diaz. Dr. Comas-Diaz is a clinical professor at the George Washington University Department of Psychiatry and Behavioral Sciences. She also has private practice in Washington, D.C. She's a past director of the Hispanic Clinic of the Yale University Department of Psychiatry, and she was a past director of the Office of Ethnic Minority Affairs at the American Psychological Association. Liliane's academic interests include multiculturalism, feminism, psychotherapy, and liberation slash decolonizing psychology, and as a scholar, Liliane is the author of over 186 academic publications. Welcome, Dr. Liliane Comas-Diaz. Thank you. Okay. Oh, how can I get back here? Oh, there we are. I'm actually very honored, and I feel privileged to be here with you. I want to thank all of the previous presenters, because they have provided an arpillera, which is what the Chilean women under the dictatorship were creating art and activism to be able to heal themselves and heal the community. So I think what's happening here is very healing. And I also want to thank you all for being here and giving me the opportunity and the honor to share with you some of my work. So I was tasked to talk about intersectionality, which is actually a feminist of color construct. And by the way, looking at your faces makes my heart smile because I feel like I'm preaching to the choir here. So again, thank you for being here. According to Crenshaw, the intersectionality relates to the diverse identity categories that intersect. There are multiple intersecting sources of oppression primarily for people of color, but also of power. Interlocking effects of systematic oppression and increase the vulnerability of us people of color and other oppressed people. In my experience, the way I learned about intersectionality is by using it as a prism for a reflection of the diversity in the human condition. So it's important that we learn about intersectionality and embody it because this is a way of learning about self and other. And intersectionality actually relates to the Native American proverb. It takes a thousand voices to tell a single story. In other words, it takes a thousand or more positionalities for us to understand a single individual. And for us to understand ourselves as well. Again, I have learned, at least that applies to me, maybe for some of you, that if you think about intersectionality as a metaphor for an iceberg, and I'm gonna explain that a little bit more. Intersectionality is like an iceberg because many of the qualities, identities of individuals, they are visible, like in the surface of an iceberg. And this include age, visible ethnicity, gender, skin color, physical appearance, and physical illnesses that are visible. That's how we, when we see our clients, our patients, we get impacted by how they look. However, intersectionality is also like being aware that below the iceberg surface, like below the person you're seeing, are less visible things such as mental illness. Maybe not in this group because we are mental health professionals, but sometimes they are not as visible. Sexual orientation, religion, spirituality, trauma, but especially for oppressed communities, racial trauma, which the DSM-III doesn't, four, five, fifth, whatever, doesn't acknowledge racial trauma as a condition. Political, philosophical orientation, and many others that we have not even encountered yet. Now, I'm sure this group know that Eurocentric mainstream therapy tends to ignore, among other things, intersectionality because Eurocentric values inform, and I would say shape, mainstream definitions of health, stress, illness, trauma, treatment, and who we are as mental health professionals. Now, this is an interesting painting by Remedios Varo, who was a feminist painter, and if you can see, this woman is having, well, the title of this painting is Leaving the Psychiatrist's Office. So we can see how she, the client, is leaving with the head of the psychiatrist or the psychologist, social worker, and carrying something else which we can identify as her inner self, and that is that the way we have been practicing mental health therapy is not addressing the reality of what had been told before, and that is being human. So, I just realized that we have a... Social inequalities and psychological problems, we tend to forget that not only for people of color and oppressed people, but for everyone who suffer from this, that many of the psychological problems that we as clinicians treat, are actually the consequence of sociopolitical inequalities such as racism, sexism, classism, homophobia, ageism, poverty, you name it, all the isms, and that all of these isms wounds people's psyche, and we need to address all of these issues. And we need to address all of these issues if we want to be effective as clinicians. So, one of the reasons we're here is because we are asked whether intersectional therapeutic practices can be taught or learned. So what do you think? Yeah, name, what? Yes, okay, good. Yes, and there's some psychological techniques and practices that help us to do that. One is becoming aware that, let me get back here, that we are living in an intersectional life, in an intersectional world. The second one is to embrace an intersectional humble perspective. In other words, know what you know and what we don't know. Examine power relations, and some of the presenters before have been talking about that. Practice a reflective intersectional and multicultural therapy through a self and other awareness. So, these intersectional therapeutic practices mean that we have to understand that we live in an intersectional, did I say that already? Multicultural and transcultural world, that we need to adopt a cultural humility perspective. That's important to practice an ongoing analysis of intersectionality and our cultural embeddedness, and that it's important that we engage in a reflective practice that includes multicultural, gender, and all kinds of intersectionality self-awareness. So, here are some ways that you can enhance your understanding of yourself and others. One is by exploring our positionalities. In other words, who we are within multiple contexts. Engaging in addressing yourself and your client or patient. We're gonna talk about addressing yourself and your client or patient. We're gonna talk about addressing, and Dr. Turner will be expanding on addressing as well. And conducting a power differential analysis. In terms of positionalities, and if you remember the first slide I was talking about, I included some of my positionalities, she, her, nosotros, that kind of thing. Sort of affirming who I was in terms of letting others know who I am as opposed to them assuming that they understand who I am by the way I look and the way I sound. So, positionalities refers to the intersecting identity of context that grounds us in who we are, but most importantly, who we are in becoming. And that's what the, who we are in becoming is the one that we want to address by being here. So, positionalities refer to the multiple identities that we have due to the context that we embed. And that is culture, gender, sexual orientation, race, ancestry, ethnicity, socioeconomic status, past and present, because it's important that we ask socioeconomic status of people in the here and now. But what about the way they grew up? That's still important because we are carrying our heritage, okay? Physical abilities or disabilities, religions, spirituality, political, philosophical orientations, and many others that we may have and we hold as important to who we are as people. So, addressing as I mentioned, Dr. Turner will be talking more about it, but it means being aware of age and generation, developmental disability, disabilities that are acquired, religion, spirituality, ethnicity, blah, blah, blah, blah. But not only of the patient, but also of yourself in terms of how you're creating a communion with your client or patient. So, I'm very excited about this power differential analysis, because as has been indicated before, we tend not to think of power and not to analyze power differences, particularly when we're dealing with clients, because there's a huge power differential in a therapeutic relationship. And if you're aware of that, then you can do something about it. And what it means is to unfold the similarities and differences between you and your clients or patients, compare your patient or client, cultural group, social status, with your own cultural group, social status. Identify and challenge internalized privilege and internalized and externalized oppression, both internal and external. And to help you understand the perspective of your clients or patients. We tend to maybe think that we know our own perspective. Maybe, maybe not. But it's important to really, if you want to help someone to heal, to understand their perspective. So how do we do that? It's a very simple way. First of all, you want to do it. It's the intent to want to do it. So a very simple way is to write your areas of oppression in a column under the letter what, O. Write your areas of privilege in a paper, whatever you want to write it, under the letter P. Include areas of historical oppression and privilege because in a way we tend to forget that we have both areas of oppression and of privilege. Do the same thing with your patient or client and then compare your own results with those of your patients. It's up to you if you want to just do that exercise by yourself and not share with your patient or client. In feminist therapy, there is a tendency to share that with your client or patient and who knows why? To diminish the huge difference in power between the therapist, the doctor, and the client. As I said before, we have to remember that we have both areas of privilege and oppression. And if you happen to have white privilege, it's important that you feel free to unpack it. But I would extend that to if you happen to know which areas of privilege you have regardless of were people of color or not, it's important to be aware of that as well and examine it and see how that can be transmuted in your therapeutic relationship. Be aware of it, that's what I'm asking you to do. Now this is what I'm very excited about, particularly with this group. And that is if you're a member of an oppressed group, it is important that we embrace resistance. Even though resistance sometimes have a bad reputation, in this particular case, resistance is powerful because it fosters identity transformation. It's like using yourself as a victim. It's like it's an energized way of saying I'm going to resist oppression and I'm going to transform it. And the resistance offers multiple understanding of intersectional oppressions. It's important to do that analysis for yourself. Advances and in-crossing, moving across realities and more importantly, shaping a new ground, creating a new, the dream of creating a new world, because this is what we want to do within our oppression, is shaping a new ground. And it promotes coalition building. When we become aware that we're resisting oppression, we look at other oppressed people and groups as our siblings and that gives us a lot of strength and paradoxically, power. These are my references, but I want to show you this last slide. And this is what I'm talking about. When we connect with other people who feel, who are oppressed and who feel oppressed, because oppression is not about the external world only, it's an interaction with external and internal realities. When we see oppression as resistance, as empowering, and what I mean by that, not only seeing our oppression per se, but seeing the oppression of our brothers and sisters and other people, that really makes us extremely powerful. Thank you. Thank you so much, Dr. Comas-Diaz. I would like to invite Dr. Erlondra Turner to the podium. Dr. Turner is a licensed psychologist and owner of Turner Psychological and Consulting Services. Dr. Turner is also a tenured professor at Pepperdine University, a nationally recognized speaker and mental health media contributor. His innovative work on racial justice has led him to consult for organizations like the NFL, Sesame Street, and Instagram. As a sought after expert, Dr. Turner has been quoted by top media sources, including CNN, the New York Times, Washington Post, NPR, Oprah Magazine, and more. He is the author of Mental Health Among African Americans, Innovations in Research and Practice, and Raising Resilient Black Kids, A Parent's Guide to Helping Children Cope with Racial Stress, Manage Emotions, and Thrive. In 2020, Dr. Turner made history as the first black man to serve as president of the Society of Child and Family Policy and Practice, Division 37 of the American Psychological Association. In 2021, he launched his Therapy for Black Kids, which provides mental health tech support and psychoeducation resources to help parents raise mentally healthy kids in the 21st century. Dr. Turner is a passionate advocate for advancing mental health care, particularly in underserved communities, and continues to shape the national conversation on mental wellness and racial equity. Dr. Turner, welcome. Thank you so much. Thank you. Great, thank you. Is my, can you hear me okay? Okay, let's make sure the mic was on. I'm gonna probably look at my notes a little bit for the sake of time in my ADHD so that I don't go too far off track, but I'm excited to speak with you all today about mental health, and I'm gonna broadly overview some multicultural considerations, and then talk a little bit more specifically about the importance of intersectionality and what are some tools that you can use to do that in your practice. And then I'll try to wrap up with a brief video demonstration just to give you an idea about what that may look like in the actual clinical practice. So this is my disclosure here. Skip over that. So just briefly overviewing some of the demographics. I know we've talked a lot today about some of the disparities that sort of exist as it relates to mental health. We know that currently mental health is a serious concern in this country. It has been for a really long time, but we know that about 23% of adults in the U.S. in the past year have actually been diagnosed with a mental health condition, according to recent data. We also know that when we look at youth mental health, that about one in five have seriously considered suicide, and then 10% of those have actually attempted suicide. And so this is an ongoing concern, especially among black youth, where we're seeing rates that are continually increasing among black adolescents, especially black boys. In terms of some of the disparities, we know that individuals from racial and ethnic groups tend to utilize mental health services less often than their counterparts. And one of the things that have stood out for me, looking at this research over the years, is that we know that insurance can help to decrease some of these concerns, but if we control for that, we also see that these disparities continue to exist. And so, even when individuals do have access to health insurance, that doesn't always address some of the disparities that we see as it relates to mental health. So, I want to talk a little bit about this as it relates to insurance. While we know that that is one barrier, obviously there can be many barriers that exist as it relates to different minoritized groups receiving care. One of the things that came out in this recent data from a survey from Mental Health America was noting that for a lot of individuals, when it comes to seeking mental health services, oftentimes they have to seek that out of network. One of the things that I see, especially as it relates to psychology, is that many psychologists are deciding not to go in network for mental health care because of some of the challenges and considerations with labels, and for many minoritized groups, oftentimes they do have some concerns about being labeled, which prevents them from accessing care. We know that also, in order to bill for insurance, that you have to have a diagnosis. And we know that every client that comes to our office doesn't necessarily meet the criteria for a DSM diagnosis, which may create some challenges for some clinicians providing care to individuals who may need services, and so they have opted to decide not to be paneled by insurance providers because it provides a better opportunity for them to actually provide care to those in need in their communities. So this particular data that's noted here indicates that when we think about those that are seeking out-of-network services, that they're about three times more likely to seek out-of-network services for behavioral health providers. And you can see here from those numbers as you look at different specialty areas that that number tends to vary. For psychologists, about 10% of individuals tend to seek care out-of-network for a variety of reasons. Sometimes people don't want to have their records tracked in terms of their mental health, and so they may not decide to use their insurance, even though they actually have care. So these are some serious challenges that we need to be mindful of. Another consideration that comes up is related to inpatient treatment. So about 19 times more likely to seek mental health care services for inpatient care out-of-network. When I was working in the inpatient setting, one of the challenges that I saw was that many of my clients actually had limited services for inpatient care. And so sometimes when you sort of reach that limit, you have to go out-of-network in order to maintain your adequate care. In some instances, insurance companies are flexible and you can sort of work out some agreement where they may provide additional services. But as we see, the conversation needs to continue as it relates to advocacy, so that us as professionals continue to talk to policymakers about the need to make sure that we're increasing the access to these communities that are actually suffering. Another thing that I want to bring our attention to is that while we see that there are these huge disparities, we also know that there are about 340 individuals for every one mental health provider. So this is a serious concern because while there are many individuals who need care, we also know that there is not enough workforce to provide adequate care to these individuals. And this is going to be a growing concern over the next couple of years. So there is some data that has been shown that when we look at mental health profession, that these disparities are going to continue to grow and that the rates of providers are actually going to decrease in the next 15 years. And so we're going to see a larger challenge as it relates to addressing the mental health needs of our communities. So I want to share with you some data here. This is from the workforce data from the American Psychological Association. And so I highlight this because I do think that it's important when we think about how do we address some of the diversity within the workforce that this is challenging across multiple professions. If you look at data from psychologists, about 80 to 90% actually identify as white. And I highlight this because I know that one of the concerns that oftentimes comes up is that for many individuals, they do want to work with someone that looks like them or that's from their own community. While that's not the only factor that may be considered as it relates to increasing engagement, we know that it is important to many individuals in our communities. We also know that as this conversation that we're having today as it relates to cultural competency intersectionality, that for many providers, that while individuals are gonna be seeking care, they're probably gonna be working with someone that doesn't look like them. And so the need to engage in cultural competency and cultural sensitivity is much more important as it relates to the mental health profession and addressing the needs of multiple communities. So I want to just sort of briefly highlight as we've been talking about today the importance of cultural competency. This was sort of touched on a little bit earlier today. And so I'll just read this directly. Our research has demonstrated that multicultural competence and sensitivity is important to strengthen the therapeutic alliance. Obviously, all of us in this room probably know that. But one of the things that has really, that resonated with me over the years of doing this work is that we think about the therapeutic alliance. There are so many factors that relates to this. And oftentimes when we think about intersectionality characteristics, sort of disclosing our own intersecting identities or even asking important questions of our clients as it relates to their experience related to those identities, that sometimes those questions are not asked or discussed, which can impact that therapeutic relationship and that alliance, which may ultimately lead to early termination or dropout of our clients and prevents them from getting the adequate care that they need. So I won't spend a lot of time on this. I know that most of us in this room are familiar about what's involved in cultural competency, our cultural sensitivity. I do want to reference this because I think a lot of times when we look at the literature, we're thinking about these provider characteristics that are important. One of those being that this sense of cultural awareness and beliefs where we really want to understand who we are, what our beliefs are, and how we apply that to our clients that we're working with. And in my own work, I think one of the considerations that has come up over the years is that as a psychologist, I understand what is my role in that treatment process, what's involved in therapy. Sometimes our clients have a very different view and expectation about what's involved in that process and relationship. And so it really is important for me to make sure that I bridge that gap in terms of what my own understanding is and what they perceive as being what is expected in terms of that therapeutic relationship. We also know that understanding knowledge of our client is important. We can get this from textbooks, we can get this from trainings. The piece that I want to challenge us to think about is this piece of how do we better understand our clients? Sometimes we want to have a understanding that we should sort of ask our client to teach us about who they are. And I want to challenge us to not do that because I think oftentimes for many of our clients, when you come into that room and they show up in that space and you're asking them questions about their own identity, they feel like you don't understand who they are. And so that actually impacts and impairs that therapeutic relationship. And so making sure that you have some knowledge about the client and then build on that is much more important than having the client teach you about the experiences and who they are. The last piece is having some skills in implementing a culturally sensitive approach. This is the area where I think that oftentimes our training and education tends to fail. I think we focus a lot on the first two factors as it relates to multicultural competence and not so much on the skills piece. As I sort of teach my students in my program, one of the things that I often discuss is from my own experience that I will say most of the things that I've learned as it relates to multicultural competence I've gained after I graduated with my PhD. So yes, I have really excellent training in terms of therapeutic skills, but when it comes to diversity, multiculturalism, intersectionality, all of those things I think I did primarily on my own through continuing education, reading, et cetera, that has really helped me to really engage with my clients much more effectively than I did coming out of my graduate program. One of the pieces that was touched on earlier that sort of resonated with me was that we have this idea about self-disclosure. And for many of us, we were taught in our programs like not to self-disclose certain things to our clients. And I think in certain instances that actually might impede that relationship. And so I do think that what I tend to use as sort of this strategic disclosure where there are really important instances where I might disclose certain aspects about my own identity to really sort of bring down that wall with my client and also even out the imbalance that oftentimes is either present or perceived as it relates to the power differentials that exist within that therapeutic setting. So I show this diagram just to sort of highlight again why is it even important for us to think about multicultural competence or cultural sensitivity. And so this is some work that has been published several years ago that talks about sort of three main considerations that might be important as it relates to outcomes that exist. And so these outcomes that are listed here on the far side include improved clinical engagement, improved treatment retention, improved treatment retention, as well as improving different types of outcomes. And so we know that if we can make sure that there is some type of therapeutic match with the client in terms of the contextual circumstances, experiential match in terms of the therapeutic relationship, and also interpersonal feelings of being known and connected, that all of those things are really important to address these potential outcomes that we're all concerned about in our clinical work. So this is a quote from a book chapter that I just co-authored recently. And so when we think about intersectionality and exploration of the unique and distinct social experiences of those who have intersectional identities helps us understand the lived realities of living in a society that may offer power, privilege in some instances or context, while also subjugating those with intersecting identities in other contexts. And so as Dr. Kombos-Diaz talked about earlier, understanding these unique experiences that our clients navigate in terms of their day-to-day lives is really important in terms of how do we engage with them, understand what their particular needs and challenges are, and how we can better serve those individuals. So hopefully you can see this okay. I'm realizing now that it may not be as large as I thought it was when I put it on my slide. But this is the addressing framework that was referenced earlier. And so this is one modeling approach that can really be helpful for you to begin to explore intersecting identities with your clients. The addressing framework really facilitates this work by calling attention to these individual characteristics that were outlined earlier in terms of age, generational status, any developmental concerns or disabilities, looking at relationships and spirituality, ethnicity, race, et cetera, that were outlined briefly earlier. And also I think a really big piece that I think is important for us to consider as it relates to intersectionality in this particular framework is how do we consider while we can also have power or privilege in certain areas, that there can also be instances where we may experience some levels of oppression, as well as similar experiences where we may experience some levels of oppression, as well as similar factors may exist for our clients. And so one sort of brief example that I give as it relates to classism and this idea that was referenced earlier in terms of thinking about the sort of past and the present of our clients as it relates to social class. And so for some individuals, while they may be currently in let's say a middle upper class background in terms of their socioeconomic status, they may have grew up in a sort of middle to lower or under-resourced community. And so how does that person function in a current society given their past experiences might really be important because that may also shape their worldview. And so you can have individuals who may be in a current sort of really higher social class status or environment, but also may be functioning from some of the beliefs and value systems that they sort of grew up in that can also be impacting their current functioning. And you could see this potentially as it relates to individuals in let's say mental health care where they grew up in a home where mental health wasn't discussed. They didn't see therapy as being something that was important or useful for their communities. And so that may actually impede or prevent them from engaging in a therapeutic space currently, even though they have the resources to do so and also have awareness that seeking out services can really be helpful for them to address their particular mental health concerns. So I'm going to briefly sort of show a demonstration, hopefully the tech works for us. This is a video that I produced with the American Psychological Association on working with black and African-American clients. And without getting into a sort of long discussion as it relates to terminology, I do think that it's important to think about the differences and the nuances between black and African-American communities. Oftentimes in the literature, these terms are used interchangeably, but we also want to recognize that for individuals who may identify as say Haitian, Jamaican, or Nigerian descent, that there may be some really unique cultural aspects that may be important to those communities. And so I really want us to be more mindful about that as we think about intersectionality and cultural competency. So although I hate watching myself and I have to say this every time I play this video, either here or in classes, I do think that it is helpful and important to sort of see what this may look like in a sort of interaction with the client. So as noted, this is going to be a brief demonstration of a therapy session with a African-American male client that has some issues related to sexuality that has resulted in some depression symptoms. And so if you can play the clip for me, we'll hopefully it's cued up as it's in the spot and we'll watch a couple of minutes of it. I guess maybe the language of words to describe, you know, some things that you were sort of dealing with and so I was curious about, you know, what was that, that you were sort of alluding to? Well, it was more specifically my sexuality. I feel like, I feel like I really figured out what my sexuality was. Figured out who I was from that aspect in college. You know, I feel like I grew up in a strict household and I couldn't have much fun. And once I got to college, I learned about who I was. I didn't realize it until college that I identify as bisexual. And just that in itself was just shocking for me. And, you know, what do I, how do I tell my parents and how does this affect not only my upbringing but my upbringing religiously? And, you know, I still believe in the idea of men and women. I wouldn't be here without those beliefs, but, you know, the world's changed, you know? And there are other, there are other options out there for lack of a better term. For me, that's when I, college was when I had my fun and I learned, like, I sincerely identify as bisexual. And, you know, this is kind of when therapy needed to begin because, you know, I still wanted to, you know, be with a woman, but having also the infatuation of a man as well really changed how I thought about things and what my life was going to be moving forward, you know? And yeah, I mean, you know, it's not like I really had anyone to talk to, you know? I don't have siblings and, you know, my parents are very old school. You know, they're just happy that I got a job, you know what I mean? And I'm working and I'm leading the Christian life, you know, but yeah, that's, I think that was the huge change for me. And I wanted to, you know, I mean, there was, there were negative times with that too, because, you know, yeah, I mean, like graduation, for example, like, you know, I was, you know, I was in a relationship with Toya at the time and we, you know, we graduated together, you know, we built this life together, but, you know, I could, I feel like I couldn't celebrate fully, you know, about, because, you know, I was involved with other individuals. I couldn't even tell her, you know? So if I felt like I really just made a choice post-graduation to just be with her and lead this monogamous lifestyle that, as you should, you know, you know, to who's standards though, like, yeah, I think I feel like I just made a life decision there and I'm here now, you know, you know. I guess maybe the language of words to describe, you know, some things that you were sort of dealing with and so I was curious. Thank you. So there were, obviously there's a lot of context that's lost here, but one of the things that I do want to sort of preference as I was doing this video, and this is not a real client, by the way, was really making that decision about, do I interrupt his narrative or do I listen to his story? And so I think in that moment, really understanding for this client, for black men, sometimes it might be really difficult, it's challenging to open up and share this side and so really not, decided not to interrupt that narrative so that way he could be able to sort of be able to open up and share those things that he has discussed. But connecting this back to the addressing model as it's noted here on the slide, some of the characteristics that you may want to consider, just to highlight a couple of things from this client and from that particular example, one of the things that he talked about was not being able to maybe share and talk about certain things with his parents because of these generational differences. And so as it relates to his sexuality, them growing up in a very different time than he is, it may make him really, maybe difficult to explore and talk about those particular aspects of his life. I mean, he put on those things a lot throughout the session in terms of talking about how these are these like expectations of how things should be that I think really influences his own belief systems about how he interacts and navigates his own life as well. The influence of religious beliefs also came up a lot in this interaction. So he mentioned the Christianity pieces as well, growing up in a really Christian home, but now currently not identifying as Christian, identifying as more spiritual, but those values still impact the ways he navigates his life as well. So as was noted earlier today, we don't oftentimes talk about maybe religion and spirituality with our clients, but for some of our clients, that might be really important to be able to explore with them as well. And so I won't walk through all of these for the sake of time, but just sort of highlighting that as was noted earlier, there are many aspects of someone's identity that may need to be explored. Some of those things might be more visible that we can understand or talk about or maybe more comfortable talking about as it relates to race. Others that may be less observable that may be also important and start really connecting it back to the CFI that was discussed earlier. And one of the things that I think is really important is if you're not gonna walk through the whole item or the whole questionnaire, which there may be others that may have some disagreement with me on that. I do think that the items eight is really important because while a client has multiple identities, there may be a few of those that may be more central to who they are. And so I like that question eight because it then provides an opportunity for the client to really verbalize what is the most important aspect of my identity or those social identities that might be most important to me and how I'm sort of navigating my own life. A couple of additional considerations that you want to talk about is really exploring privilege and oppression as the foundation of counseling. And so really when we think about that therapeutic relationship that embedded within that is this power dynamic. And so for us as professionals, while we may try to neutralize that, oftentimes there is this dynamic where clients see us as the person that controls every aspect of that session and what happens after that. And so really making sure that you sort of discuss those dynamics and how it makes the client feel is really important to moving forward and improving cultural competency and rapport in terms of that relationship. I also think that it is important that you discuss race and ethnicity as a component of treatment. And so as was highlighted earlier, thinking about what types of experiences and environments those individuals may navigate is really important. So it's much less about just talking about their race and their ethnicity, but more about understanding their background and their culture that really influences how they may be functioning in society. And one of the things that I know and what we know from the literature is that this is an area where we make it a really difficult conversation, that having the conversation about race is perceived as being something that you shouldn't have oftentimes. And so it might be really challenging for some clinicians to really talk about these types of issues, which then may make it really challenging for clients to be able to feel comfortable in that space if you haven't brought up some of those considerations that may be important as it relates to their racial identity. The final piece is to think about using strength-based and culturally relevant treatments. And so I think for most of us, this focus on evidence-based practice is sort of embedded in our training, and oftentimes we think about more culturally responsive treatments. Those are not something that we're sort of taught automatically. We have to learn about those through continuing education aspects, and so really recognizing that these are things that we have to really focus on often so that we can be able to make sure that we adequately address the needs of our client. And I know we're at time, so I'm going to just sort of briefly talk about this and stop. In terms of working with black patients in particular, really do try to avoid being defensive. I think that oftentimes when we're working with clients, especially if it's from a sort of dissimilar dyad, that it can be really difficult to not be defensive, and that does prevent the client from feeling comfortable and being able to maybe open up and feel like they're seen and heard in those settings. You want to acknowledge the experiences of racial oppression if the client has noticed some of those. And for me, one of the challenging pieces is I think oftentimes as a mental health provider, we want to sort of rationalize certain situations or maybe challenge if it was related to racism or oppression. And so I think you really want to make sure that you validate the client's experience, they were the one that was present, and really try to understand what happened in that situation as opposed to being able to sort of explore, well, maybe it could have been this reason why the person behaved that way as opposed to responding in sort of an oppressive situation. I will stop there. I want to thank you for inviting me to speak and also acknowledge my lab who has contributed to my projects. Thank you so much, Dr. Turner, Dr. Shakira, Dr. Lillian Comas-Diaz. If you can join us up front, we'll take a few questions from the audience. Please utilize the microphone in the aisle. So thanks so much for all the presentations. So Dr. Turner, it's very nice to see that video. It's like almost feels like sitting in our office and like having these discussions feels very real. Can you give us some points how to navigate that very, very, very sensitive ground when people bring in their faith, like, for example, like growing up in a not even strict household, just Christian household, Muslim household, you know, where there's like so much, you know, intergenerational and faith-based kind of, you know, conflicts with the sexual orientation. What are like good ways to navigate it very sensitively? I find sometimes challenging not to offend in any way, but still be there for them and give them space. I just had someone who had been seeing their therapist for four years, never talked about sexuality or anything, although that's like the primary conflict. So I was thankful that he felt that space that, you know, he did share with me. But like where to go from here? Yeah, I think you brought up a really good point about I think when we talk about sexuality that oftentimes we don't ask that question or dive into it. And I think especially when there is like heterosexual privilege, so if someone doesn't like look a certain way, then we may not even ask that question. We may like assume that they are heterosexual or identify as straight. And so I think that's a starting point of that I, as I sort of look back on my own training, have to sort of unlearn and really working with adolescents at the time to really make sure that I approach that in a conversation where I say, do you like boys, girls, or both? Or another way to phrase that question in terms of if I see a female, a girl to say, do you have a boyfriend? So I think we have to really start there as a starting point. I think the other piece is really making sure that we begin to open up and be sort of critically examine what it means to belong to religious groups and sort of what we may view from an outsider in that community might be very different than someone's experience that belongs to that group. And so I think really making sure that we sort of try to understand their perspective as it relates to what it means to belong to that group, how has it been helpful or even hurtful. And so I think language is really important because there can be really helpful aspects of being let's say a Christian, but then there also can be like church hurt for someone who identifies as a sexual minority where they may not have been in a church where that was really supportive. And so that may sort of push them away and they may sort of struggle with how do I still stick with this community or these practices that also have been hurtful, but I know that I can benefit from some of these sort of religious values that also might be important to me. So I think that's something that I would sort of think about in terms of my own clients about how do I explore their religion and spirituality and how does that connect back to sort of what they may be going through at the moment. If I may add something, thank you for what you said and thank you for that question. I'm here in DC and I see a lot of international people, so I always become aware that I don't know. So in my therapeutic relationship, I empower, I try to empower the client, the patient with you hold the knowledge about your culture. Help me understand how it is for you to be X, Y, and Z. And that way I can take that information and try to help you. So that's a way that I would address because the scene about sexual orientation, depending as you will know in some different cultures, is such a taboo that sometimes even the client patient silences him or herself or themself and it's important to just be there when the client, the patient somewhat tiptoes on this topic and you just follow it. Tell me more about it. So it is a challenge, but it's a privilege to be a witness. Thank you for that question again. Yeah, and just quickly, I think we also can be very hard on ourselves. So it's important to recognize that all we can do is try to co-create a healing and validating space, but oftentimes the literature on self-disclosure shows that before anybody can share those pieces to others, they have to be willing to confront them to themselves. And so in the kind of therapeutic space that we co-create, it's ultimately not up to us and therefore it's totally okay how much or how little they share as long as we're doing right by our sort of sacred and reverent obligation to them. Thank you. Hi. My name is Wamba Malakani. Okay. You can hear me better. My name is Wamba Malakani. I'm a third-year resident at a community program in Detroit, Michigan. Thank you for your talk. And I'm also a SAMHSA fellow here. My question is, in terms of therapy sessions, so as a third-year, of course, in residency, this is when we kind of really have our main outpatient year and we're performing a lot of therapy sessions. And so I'm wondering if you could talk a little bit more about that. I mean, I'm a third-year resident at a community program in Detroit, Michigan. Thank you for your talk. And I'm also a SAMHSA fellow here. My question is, in terms of therapy sessions, so as a third-year, of course, in residency, One thing I struggle with, and I've noticed, is with our American Western society, we're very individualized. And I've observed that when you're learning CBT or DBT and you're teaching patients how to set limits, especially with children, if they're coming from multicultural societies where individualism may not be their home base of how they structure their problems and how they affect change, how do you, how are you culturally sensitive and aware of that? And how do you actually teach them how to set those limits in that structure? For example, I am, my parents are from Africa. My mom's from West Africa, Sierra Lone, my dad's from Congo. And in our community, even after you graduate and you become an adult, there are still decisions and behaviors that you still consult your family, even though you could even, making your own salary, living completely away from home, married, whatever the case may be. So how do you set those limits and teach patients to set those limits? I can start, maybe, and then we can each kind of weigh in, because I think we all have lots of ways in which this unfolds. So thank you for highlighting that. I think that the biggest piece here is, especially as a fellow and in your level of training, by the way, shout out to all the fellows in the room. I was a former fellow. Thank you, SAMHSA. Thank you, APA, for supporting me and us. What you have to do first is approach what you're learning as an opportunity to understand, but also critically question, theories of change that are embedded within existing psychotherapeutic interventions. What that allows you to do is to not completely dismiss something, but be able to understand, well, the theory of change here, for example, in a DBT orientation, is this, and it's based on this. How I can apply that in a contextually appropriate way is going to vary, and I have to be able to individuate and integrate. But that's hard to do in training, because it's taught in a very categorical way, whereas in practice, we're always interweaving different theories of change, meeting the patient where they're at. One of the things we've tried to do is look at empirical ways to evaluate those modifications. For example, we've been piloting a DBT-informed group for black and African-American parents to focus on ways in which cultural affirmation and validation have to be integrated into some of these conversations. We do it on weekends, because that's when people are available, but the last time we did it, I modified the session, and we did a mindful practice session on belonging and joy. And I asked the parents to reflect on moments of their lives where they felt a sense of belonging and joy, and there's this beautiful diversity of African-Caribbean and ethnic black American in the room. But what I did then was I asked them to imagine that experience as a parent in their household, and they all experienced dissonance, because they realized that their children's version of what that would be like would be very different. And then we tried to co-create space for them to grieve that loss, but still embrace that the children will build their own relationship with those traditions, and that as they parent, they don't have to completely forget or neglect that part of it. So I think there's ways in which we can integrate and interweave the concepts you're describing into these therapies, and also challenge ourselves to find and research other approaches. Thank you. And thank you for that question, because we're living in an increasingly multicultural and trans-cultural world. And maybe because I live here and work here in Washington, DC, there's a lot of international, so I see this situation that you present quite often. I actually share with the patient that I'm here your witness, and I'd like to hear from you how all of these multiple intersecting realities are for you, like how do you deal with your parents, with your friends? So I try to empower the patient to become a storyteller, but also to imagine him, herself, and them, how they are in the process of becoming, and how they see themselves in the future. I love movies, by the way, so I feel sometimes that doing therapy is like being in a movie, participating, co-creating, I think is the term, a new reality. So I actually like when situations like that happen, because it's a way to accompany, in the liberation psychology way, the client or the patient, in this wonderful journey, which can be very painful as well, but my role is to be a magician, or try to be a magician, and make that pain become joy, as you were saying. Thank you again for that question. And I'll just be brief. I think I like what has already been said, but I also want to acknowledge the fact that it's really important for us as clinicians to make sure that we explore the origins of why people got to a certain place, and also making sure that we don't get so caught up in this sort of Western view that we may be taught in terms of our own training, because I think there can be times where we approach things from a very individualistic perspective with our clients that actually can be harmful for them, based upon their culture, and actually may make them more distressed. And so I think really being able to explore that is really important, and so I appreciate you bringing up that question. We'll take one more question. Hi. I was listening to your talks, and it occurred to me that, in between Bhuja and my session, and the three of you, all of us actually share a similarity, which is that we've developed spaces of our own to be able to kind of promote the work that we're interested in, but all of us have had to come to this work critiquing the models of training that we've had beforehand, right? So the question for me, and I wonder whether you all would be interested in exploring this, is what is it about our training that is so deficient that we all have to come to this work and promote it in separate spaces that we create, and that what can we do together as a community to help the APA encourage greater advocacy so that way our training models are really teaching the importance of cross-cultural care right from the outset? When you're talking about how you had to supplement your training with a lot of reading and writing, then it raises a question, well, why weren't you trained to do that, right? Why did you have to engage in that extra protected time and space for yourself? I mean, I know I've had to do that. I know you've had to do that in the APA SAMHSA Fellowship. I mean, we're just talking about creating a module for people already in practice, right? So I'm wondering whether that's something that maybe all of us are sharing and we're not necessarily acknowledging, and how that can be a stance for advocacy with the APA. Yeah. I mean, yeah, I definitely would like to start. One of the things that I had planned to reference, which I went off my notes so I didn't reference, was I think that when we talk about education and training, that there are these core competencies. And oftentimes, while we talk a lot about diversity and multiculturalism, it is not part of our core competencies. For most of us, there is one class potentially that we take in order to graduate, and then we're sent off into the world. And that's obviously not representative of the class and the communities that we often work with. And so I think we have to sort of really recreate what this education and training space should be like, so that way multiculturalism is more embedded throughout this training process, as opposed to sort of being like an add-on. Thank you. Well, I learned the language of the aggressor, of the oppressor, so I can master it, so I can understand it, and I can change it in my practice. Because most of us, if not all of us, have areas of oppression and privilege. Sometimes it's hard to find the privilege, but if you dig it, dig it, it's there. Or if you can create it. And you know, dealing with multiplicity is important, because it's not that you're becoming crazy, it's that you're becoming conversant with multiple realities. If I'm going too high here, let me know if I can. So maybe because I also see a very international, very African American, very Latino, very diverse population here in D.C., I had to deal with what else can be done besides the regular psychology, psychiatry. So I became quite critical, but more than being critical, creative in creating new ways of listening to people's testimonials, telling me what their life is all about. And then what I do is I drink from that perspective, and I use it in terms of feed what the client, patient needs at that moment. But I also use it in a way of creating new visions of themselves and who they are in becoming. Did that make sense? Thank you. I have so much to say, but I can probably hear everybody's stomachs grumbling. So I'm going to try to distill it down, but I'm going to be very psychiatry focused, because I think it's important to contextualize. In psychiatry, we're unique in the house of medicine, because we know the experiences of stigmatization and, again, prejudicial and structural underfunding of the work we do. But we don't recognize our power is invisible to us in terms of professionalization of our field, ability to prescribe, and the ways in which we exist outside of medicine. We can hold each of those in each hand and really lean into this in a unique way. But because I've spent so much of my career looking at how we perform or think about medical education, I think one of the sort of starting points for me is to assume that there's nothing that I can do about that big, wicked problem. But what I have to start with is how I have to be hyper-vigilant about it. And as an administrator or leader, how I create structures and sustainable funding so that others in my department can spend as much of their time teaching, coaching, and mentoring one another. And that's the way, in shifts and in strides, and sometimes in setbacks, we start to see change happen. What we can't do is we have to be hyper-vigilant about it. And as an administrator, how I create structures and sustainable funding so that others in my department can spend as much of their time teaching, coaching, and mentoring one another. What we can't do is compartmentalize and try to just focus on one end of the continuum of education. Because I know our organizations are talking about competencies. But when I'm on a panel and I'm reviewing anti-racist competency, I keep telling myself, who's going to teach this? Because most of the people I know in medical education don't have those competencies themselves. Thank you. Thank you. Let's give our panelists a round of applause for an amazing session.

cultural competency

intersectionality

systemic challenges

mental health care

biases in health education

collectivism

cultural authenticity

self-reflection

marginalized communities

disparity in services

multicultural sensitivity

Addressing Framework