On behalf of the American Psychiatric Association, I want to welcome all of you and thank you for joining. I'm Ronna Parekh, and I'm one of the presenters for today, and I'm honored to be joined by Dr. Ed Childs, a trauma surgeon and chief of surgery at Morehouse School of Medicine in Atlanta, and Ms. Nikita Natyal, a junior in high school in Southern California. The title of our presentation today is Microaggressions and Strategies to Overcome Prejudice. Before we begin our presentation, I'd like to go over some APA housekeeping items. The first is the funding and disclaimer for today's presentation and the entire series for Striving for Excellence. It's from SAMHSA and from the African American Behavioral Health Center of Excellence at the Morehouse School of Medicine. Next slide. The next slide shows that the continuing education credit, you can ascertain your credit. The APA is accredited by the ACCME, and this particular presentation, you can receive up to 1.5 Category 1 credits. This slide shows how you may download handouts. You may want to take a picture of this if you would like to receive the downloads later. And finally, we have a slide that shows how you may participate in the questions and answers. Again, you may want to take a picture of this. Thank you. So with that, we'll begin our presentation. I also just want to thank Ms. Ebony Harris from the APA's Division of Education who will be helping to advance our slides, and she's been just terrific to work with. The first slide shows that we have no disclosures to present, to disclose, or to report. And then the slide after that reviews our four objectives for today's presentation. The first is that we want to enable our learners to recognize microaggressions and the various forms. Like anything in medicine, we think it's really important to be able to recognize microaggressions that you receive or that you may be committing and the various forms of microaggressions. The second objective really cements why microaggressions are today seen in medical ground rounds and health settings. We want to demonstrate the health and mental health consequences of microaggressions. Our third objective is to utilize individual and institutional effective strategies to address microaggressions and finally engage everyone on how to create an inclusive environment. For our next slide, we begin with recognizing microaggressions and its various forms. Next slide. Some of you may know that the term microaggression was first coined by Dr. Chester Pierce and many people have built upon his work. I feel so honored that I knew Dr. Pierce. I had been mentored by him for over 20 years, first when I was a resident at the Massachusetts General Hospital in my mid-20s, and then the last seven and a half years that I was at the Massachusetts General Hospital, Dr. Pierce and I built a Center for Diversity within the Department of Psychiatry at Massachusetts General Hospital. And Dr. Pierce first wrote about microaggressions after spending quite a few years thinking about the term and trying to find a way to describe the ongoing stain of racism that African Americans, Black Americans were experiencing vis-a-vis white Americans, albeit in a more subtle form during the Jim Crow era. Dr. Pierce defined microaggressions being subtle, stunning, often automatic, and a nonverbal exchange. It was so subtle that the perpetrator wasn't aware of it. Certainly a lot of bystanders were not aware of it. And sometimes it was so subtle that even the recipient didn't know something had happened. But it was so stunning that it was clear for the recipient that something didn't feel right and something was very painful. Often automatic implied that many times it was unconscious. And then Dr. Pierce also went on to talk about it being nonverbal. As many of us know, that most communications are nonverbal, up to 85 percent of language is nonverbal. Dr. Pierce went on to say that a cumulative burden of lifetime microaggressions could contribute to physical illness and flattened self-confidence. And he was clear that certain groups, such as African Americans, were more at risk of experiencing microaggressions several times a day, every day of their life. Next slide, please. Dr. Pierce went on to talk about microaggressions infringing upon a person's time, space, energy, and mobility. And with that, I want to share with you a story that Dr. Pierce shared with me three times in the 20 years that we worked together. And each time he shared this story, it was almost with the same cadence and the same choice of words and the same sense of heaviness and a lifetime of pain. For me, it was so clear to feel that pain, it was palpable, and it also crystallized for me the impact and the significance of microaggressions. And I'd like to share that with all of you today. Dr. Pierce was on an airplane and he was sitting in the middle seat of this plane. And next to him on the aisle was an empty seat. And across the aisle in the aisle seat was a white man. And it became clear that the plane was going to be pretty packed. And Dr. Pierce had brought with him, as always, lots of books and a notepad for all the work that he was hoping to accomplish on this plane ride. As some of the final passengers were coming on board, it was clear that one of the last passengers, a white woman, was making her way to sit next to Dr. Pierce on the aisle seat. And Dr. Pierce, noting that, pulled his feet in closer to his middle seat to make room for one of his last passengers, this white woman who was going to sit next to him on the aisle seat. And just as she was about to turn in, the white man across the aisle from him stood up and offered the white woman his seat. And then the white man proceeded to take the aisle seat next to Dr. Pierce. During the rest of the airplane ride, Dr. Pierce didn't read his books or look at his notepad. Instead, he spent the entire time recounting that experience and wondering if this white man had offered this white woman his seat to make her feel more uncomfortable because she would feel uncomfortable sitting next to a black man and that he was trying to make her more uncomfortable. He also wondered whether or not this was intentional or unintentional. In effect, it was taking all of Dr. Pierce's mental energy, his mental space, his time, and it took away his mobility to pursue his own intellectual pursuits, thinking about this event. And again, he told me the story three times, almost verbatim, and always ended by saying, Dr. Perreck, I just think he maybe wanted to be more of a gentleman and give this woman more space. Today, the term microaggressions has evolved to include all minority groups or wherever people feel like they are the other. And it has now included verbal exchanges. And the most insidious aspect of a microaggression as demonstrated by that airplane story is for the recipient, they spend an enormous amount of time wondering if the perpetrator did it consciously or unconsciously. If I can have my next slide, I'd like to share with you an everyday example of a type of microaggression. And this may be very familiar to many of you joining today. This is a quote from President Barack Obama on the heels of the Trayvon Martin jury decision in July of 2013, quote, there are probably very few African American men who have not had the experience of walking across the street and hearing the locks click on the doors of cars. That happens to me, at least before I was a senator, classic example of a nonverbal exchange meant to microaggress African American men. Next slide. Dr. Chalice, would you like to share some stories around microaggressions? Thank you so much. Thank you, first of all, for a wonderful story, Dr. Pierce. I want to thank you for having the opportunity to be on this panel with you. For all of you guys who may not know the Trayvon Martin story, Trayvon Martin was a 17 year old high school junior that was from Miami, Florida. On that particular day in February, 2012, he had left Miami to visit his father and his father's new fiance in Stanford, Florida. During that visit, Trayvon had went to a convenience store. On the way back from the convenience store, Trayvon Martin was approached and murdered. On the way back from the convenience store, Trayvon Martin was dressed in a gray hoodie and jeans. George Zimmerman, the neighborhood watchman, identified Trayvon Martin as a threat. Because he was an African American male, I assume, with a hoodie, he alerted the police. The police wanted to make sure that the situation was safe, so they asked Mr. Zimmerman not to approach the suspect. However, George Zimmerman decided to take matters into his own hand, and he approached Trayvon Martin based solely on how he looked. And once he approached him, a scuffle ensued, and Trayvon Martin was shot point blank in the chest and murdered. So my question is, how should a 17 year old look to feel safe in America? I am so fortunate to be joined by my mentee today, Nikita Natchiole. She is a 17 year old, and she is a junior in high school, and she's going to share her experience around microaggression. So welcome, Nikita. And if we could have the next slide, please. Thank you. Thank you, Dr. Childs, and thank you, Dr. Parekh. I wanted to share a story about a close friend of mine from school, and for the sake of the story, we can call her Ava. Ava was getting ready for our beginning of the school year dance a couple weeks ago, and she was getting ready with a close friend of hers. She had put her dress on and her makeup on, and she was really excited about this dance. Everyone is at the beginning of the school year dance, and she was getting ready with a close friend of ours, a mutual friend. And over the summer, Ava had gotten her hair done, she'd gotten it dyed, and she'd been growing it out. I got lots of pictures of progress, growth progress, and so she was really excited. But as she was getting ready to leave, our friend looked at Ava and said, looked at her hair and said, you can't do that because she had left it natural. And she was really excited because for Ava, it had taken a long time to grow the confidence to wear her hair natural. And so when her friend said this, Ava said, well, why not? And the friend said, you just can't. And Ava was shocked by this because it was a close friend, and she was obviously also very hurt because it had taken her so long to grow the confidence to wear it natural, and this was her opportunity. But still, she took the time to straighten it after that comment and style it. Akita, can I ask you just a couple of questions? And thank you for sharing that story. And I have some comments to make as well. But the first question, can you describe what you mean by natural hair? She wanted to wear it natural? Yeah, Ava wanted to wear her hair as an afro. And can you tell us a little bit more about Ava? Ava is otherwise a very confident person. She's incredibly outgoing. She's the first one in the room to be talking to everyone. She loves fashion, and she loves history. And her race or ethnicity? Ava identifies as black. She's a proud member of the Black Student Union at my school. And when you asked her about microaggressions, did she know what you were talking about? Did she know the definition of a microaggression? Immediately. Immediately, okay. And you described her emotions as being first shocked and saddened. What were your emotions? I know you weren't there when it actually occurred, but when you were hearing the story, what were your emotions like? I was also surprised because it was a close friend of ours. And I was mad for her because I knew how excited she was about her hair. I mentioned I got a lot of pictures over the summer. She was really excited about this hair, about her new color, how long it had gotten. And she was really excited, and it destroyed her confidence. Okay. Dr. Childs, this is a story that may be occurring in high school. You and I hear about this in medicine. I have mentored, supervised countless of medical students and residents and pre-medical students, and I have really significant memories of people telling me how they were not allowed to dress a certain way, wear their hair a certain way. I have an African-American male who is now a resident, but I remember going through medical student interviews, was told that he could not put his hair in dreadlocks. So it's not a story that's just in high school. I can imagine how painful it is in high school. It's also very painful in medicine. Oh, absolutely. And we see it very frequently here in medicine, from misidentification to not identifying who the attending is in control of the service. So we see it on numerous occasions, and it's a significant issue. You know, in 2018, the Crown Act was signed, Senate Bill 188 in California, and basically that bill was to address this particular issue of how a person should look in a professional environment, and Crown stood for creating a respectful and open workspace for natural hair. And since that adoption of that bill, California was actually the first state, Nikita, so you'd be happy about that, but seven other states have adopted that legislation to help protect victims or recipients of those type of microaggressions. We've got 42 more states to go. Yes, yes, yes, yes. Thank you for sharing that. Nikita, I know you have, we're going to come back to Kate, Dave, I know, later, but you have another short story that you want to share with us, Eben, if you can, thank you. Yes, so another one of my friends from school named Nikki, I asked her if there were any examples of microaggressions that she could share with me, and although she couldn't pinpoint one specific example, she enumerated on several accounts being blamed for the coronavirus. And Nikita, can I just ask you a couple more questions? I'm the child psychiatrist here in the room, so maybe I'll ask you a few more questions. Similar to Eva, can you tell us a little bit more about Nikki, who she is, what she likes, and if you feel comfortable, sort of her race or ethnicity? Nikki is from Hong Kong. She identifies as Asian. She loves music, she plays the piano, and she also loves science. What were her emotions then, and if you spoke to her more recently, in hearing these comments, these microaggressions? I think at first hearing something like that, there was a level of pain associated, but in that conversation, the emotion she expressed to me was anger, because she felt that the comment was obviously hurtful, it was obviously incorrect, and it's a big statement to make to blame one person for an entire global pandemic. Absolutely. And anger can also be a very strong symptom of pain. How about for you, when you were hearing that, what were some of your emotions? I think it was hurt to know that she was feeling this way, and it was also anger, because I wanted to be able to be there with her to defend her from whoever the person was that said that. Okay. Now, like Ava, did she know what a microaggression was when you asked her about this? She did, yes. Okay. All right. I think it's worth mentioning, since I'm from Atlanta, and the tragedy that we had a few months ago in the Asian community, because someone went into a salon and spa to murder several workers, based on that concept, that somehow they were involved with the pandemic. Kikita, thank you for sharing both of those stories. In the next slide, to move on just a bit here, you see that many people built upon the work of Dr. Chester Pierce, and one person was Dr. Daryl Wing Sue. He's an Asian-American psychologist who continues to do so much work on microaggressions, and he further subdivided microaggressions into the following three terms. Kikita, can I invite you to go through these terms for us? Yes, thank you. Unlike Dr. Pierce, who described microaggressions as simply nonverbal communications, Dr. Sue expanded that into verbal and nonverbal. He categorized them into three different groups, and the first one is microassaults, which is the only form of microaggression that is intentional or conscious. These are explicit derogations characterized by a verbal or nonverbal attack meant to hurt the intended victim through name-calling, avoidant behavior, or purposeful discriminatory action. So, the story I just shared of Nikki being blamed for the coronavirus would be an example of a microassault. And the next two are both unintentional or unconscious. Microassaults are communications that convey rudeness and sensitivities that demean a person's heritage or identity. And lastly, micro-invalidations characterized by communications that exclude or nullify the psychological thoughts, feelings, or experiential reality of a person. Thank you. And in the next slide, we have more of a visual of these terms and some more terms. And Dr. Childs, do you want to go through this with us? Yes, I will. Thank you so much. Well, these slides actually talk about race and how, and some examples of micro-insult, micro-assault, and micro-invalidation associated with race, which could lead to an environment of microaggression. We talk a lot about confirmation bias, and that is people tend to be around people that make them comfortable. So you can develop actually an environment where this is kind of the norm, and you have to be very careful with that. What are the problems with these microaggressions? Well, first of all, you can make one feel as if they're an alien in their own place in the U.S. And it just hit on so many points and so many different levels in everyday life. I wanted to briefly talk about a story that's been in the news recently on Nicole Hannah-Jones. Nicole Hannah-Jones was a Pulitzer Prize winner for her work on the 1619 Project, and she had been recruited to the University of North Carolina. She had followed all of the steps and had the credentials to become the next chair on race and investigating and reporting things at the University of North Carolina. Her application proceeded normally until it reached the Board of Trustees, and at that point, they refused to have a vote on whether she could continue at the University of North Carolina. From that, there was a sequence of a lot of different political thoughts about that recruit, leading to a forced meeting based by the student body. And during that forced meeting, she was able to gain from a split vote of the Board of Trustees. And for all you guys who know the story of Dr. Jones, she decided not to accept that position at University of North Carolina. I think that story epitomizes some of the things, if not all of the things, that's going on with microaggression, including micro and systemic racism. So I wanted to take a moment to just read a few quotes from Dr. Hannah Jones. Since the second grade, when I began being bused into white schools, I have been fighting against people who did not think a black girl like me belonged. People who wanted to control what I did, how I spoke, how I looked, and the work I produced. And this is another quote by Dr. Hannah Jones. I have never asked for special treatment. I did not seek it here, specifically referring to the University of North Carolina incident. All I asked was to be judged by my credentials and treated fairly and equally. So I think from those statements, you could feel the pain of that person having to deal with these issues at that level of her profession. It's a powerful story, Dr. Childs, and I think so relevant for this presentation, and so glad you brought it up because it shows that, first of all, I think it's important to differentiate micro from macro, and that oftentimes for people, it's a combination, particularly for African Americans, it's a combination that daily they're receiving microaggressions, and we're going to be talking about the health implications soon, but also that they are at huge risk of macro. I was fortunate to be the Director of Diversity and Health Equity at the American Psychiatric Association for almost five years, and in that role, I oversaw multiple fellowships, including the APA SAMHSA-funded fellowship where my minority fellows would talk about their experiences with me. They would share them with me, and really in my mind, it was a question of whether or not it was micro or macro, not whether or not it was even any of those, so I so appreciate you sharing the story, and certainly Professor Jones's quotes, her comments about a lifelong history of invalidation, micro-invalidation, micro-insults, micro-assaults, and then, of course, the beautiful strategy that she engaged with, and we're going to get to strategies, but that's certainly a beautiful example of a wonderful strategy, so thank you so much. We're going to go to the next slide and see how well Dr. Childs, Nikita, and I have done so far in going through the definition of microaggression in its various forms and get the audience engaged. Nikita, do you want to go through this question with us? Yes, if you remember the story of my friend Ava who was told by our mutual friend that she could not wear her hair natural for our school dance, and then also keeping in mind the three different types of microaggressions, what kinds of microaggression did Ava experience? A, micro-assault, B, micro-insult, C, micro-invalidation, D, all of the above, or E, none of the above, and I think a poll should be coming up on your screen if you just click on the answer, the letter associated with the answer you think is correct. I could probably write, I didn't know there was going to be a quiz associated with this. So the results are in. We have zero percent for micro-assault, 50% for micro-insult, 33% for micro-invalidation, 17% for all of the above, and zero percent for none of the above. As Dr. Pierce defined microaggressions, they are from the perspective of the recipient, and since Ava felt that the comment came from a friend, someone that was such a close friend, she did not feel that it was intentional. Since micro-assaults are the only form of microaggression that are intentional or conscious, we can eliminate micro-assaults, and that leaves us with micro-insults and micro-invalidations. If you put B, micro-insults, you would be correct because the comment served to, it was a communication that hurt Ava and served to demean her racial identity, and if you put C, micro-invalidation, you would also be correct since prior to that comment, it would feel confident in her hair, and that comment served to invalidate her racial identity. Terrific. Thank you, Nikita. I have to say that Dr. Childs and I brought in somebody from a different generation to be part of this talk, in part because we wanted to learn and up our game. When she first presented this question, I thought, of course, the answer is B, and then when she went through it, I realized really how painful that experience was because it was a compounded microaggression. It was not just a micro-insult, not that that's not painful on its own, but it was an added layer because it was also an invalidation of her psychological reality, and so it tells you how complex microaggressions are. Also, I think it highlights how important it is for those of us who are in positions to supervise, to support people who experience microaggressions, and how important it is to really understand Dr. Pierce's definition of the experience of the recipient and for us to ask open-ended questions to understand a little bit more about the experience of the recipient, and if you do that with Ava, you hear that there's a communication, but there's also the nullification of her psychological reality, so great question, and congratulations to the audience for doing so well on that question. So, we're going to segue now to our second objective, which is to demonstrate the health and mental health consequences of microaggressions, and the first study that I want to review in the next slide is by Elizabeth Pascoe and her colleagues. I love this study because it looked at over 130 samples, and there's three major sequelae from this meta-analysis. The first is that perceived discrimination, which is really what a microaggression is, again, an experience of the recipient, is related to mental health and physical health outcomes, and the biggest mental health consequences are stress, anxiety, depression, even suicidal ideations, and a flattening of self-confidence, and physical health outcomes such as hypertension, insomnia, that these effects are mediated through the stress response and also adverse health behavior response. There is good news, and this study begins to talk about, and there's a burgeoning literature around ways to prevent microaggressions from affecting one's mental and physical health, and that is that social support, education like this opportunity that the APA is putting out, active coping styles, group identification can be very protective in preventing these stress pathways, and the next slide is a visual of this health impact and this process, and just to orientate you a little bit to this visual, which is one of my favorites, you see five ovals, and the top left one is perceived discrimination or microaggression, so when somebody experiences a microaggression, and again, as Dr. Pierce talked about, some groups such as African Americans, Black Americans have multiple microaggressions all day long, every day of their life. They're at risk of pathway B and D, so heightened stress response and adverse health behavior, so they don't go on that run. They don't call up a friend. They don't listen to music. They don't eat the salad that they had prepared. Instead, maybe they eat something that is not as healthy, and you can imagine if you keep having this heightened stress response or adverse health behaviors, you're at risk of pathway C and E, which is a mental health and physical health outcome, but the PASCO study also shows that with education, understanding truly what microaggressions are and that the more people that understand this, the more that they can be allies, so Nikita could be an ally to Ava and Nikki and other friends. The more that we increase our coping mechanisms, we can circumvent this process, not even at C and E, but earlier on at B and D, so that somebody doesn't have a heightened stress response. You don't have a heightened stress response from a microaggression, and you don't go to adverse health behaviors if you have this social support, and we have other studies that we want to share with you. The next slide shows a study from the American Journal of Public Health. This was published in May of 2012, and it said that just merely anticipating prejudice could lead to psychological and cardiovascular responses. I hear this over and over again from underrepresented groups in medicine. If they are in toxic environments in training, that just going in the next day before they've even started rounds or interfacing with anyone, they notice that they have adverse health responses or have adverse stress responses because they know that they're going to experience a microaggression, and in the next slide, Dr. Childs, do you want to share the study? There have been numerous studies. Dr. Johnson in the Journal of National Black Nurses Association in 2012 also showed an increase in eating disorders and depression associated with perceived discrimination, so there are multiple studies to suggest that there are physical consequences from these issues, so it's very important. In the next slide, I know that both Dr. Childs and I have talked about the health and mental health consequences of microaggressions. Nikita, you had some thoughts about the importance of microaggressions and would love to have you share. Thank you, both Dr. Childs and Dr. Parekh for talking about the health consequences of microaggressions. I kind of wanted to take a step back and just talk about the importance in general. Listening to the stories of Ava and Nikita, the stories that Dr. Parekh and Dr. Childs shared, there was a level of pain of just listening to them, and I'm sure it was only a fraction of what the recipients felt in that moment and moments after, so clearly it's important if people are hurting, and along with that, if we're not actively working towards a solution, then we risk normalizing the problem, and Ava said something similar. She said, they happen so frequently that I've kind of become desensitized to them, so by working towards a solution, by actively being aware of our verbal and nonverbal communications, we are able to prevent this problem from continuing, and also by being there for the people around us to talk to them, the recipients are able to release the burden. We're all working towards a solution because it's not just the responsibility of the recipient to prevent microaggressions. It's all of our jobs to be aware of our actions, and if we are all conscious of what we're doing, we're all part of the solution. That's terrific, Nikita. It's a nice segue to solutions, but before we get there, I wanted to just focus on a comment that you made about how important it is to realize the risk of normalizing. Dr. Charles, you and I have talked about this so much in medicine, where we hear people say, well, microaggressions are ubiquitous, so why are we making such a big deal about it, and it's so important for majority populations to realize, yes, you may experience a microaggression, but it's not the same thing as some groups who are continuously experiencing a microaggression several times a day. Can you imagine the airplane story if you had something like that happen to you multiple times? I mean, I think one time in my lifetime, I would be feeling the pain and remembering it, but at some point, it's important to remember that some groups are at greater risk, and those are the people that we really need to be allies for and really need to be coming up with solutions and institutional solutions so that everybody can really, particularly in medicine, the work is so important and grave and lives are at stake. They can focus on the work and not have to worry about having to defend themselves from these microaggressions. Absolutely, and we have to develop the tools to be resilient and the strategies to help us deal with these type of issues on a daily basis, so thank you for the work you're doing, and I heard earlier where you said you were Charles Sykes, so I'm going to put myself in that category. Well, I'm glad we have an adolescent with us, because there have been some powerful words. You know, release the burden is the three words, Dr. Charles, that you picked up on, and I can't help but to wonder if we could have helped release the burden of Dr. Pierce in the moment of his airplane story, but I'm sure countless of other stories. It's just a powerful term, and, you know, again, we're going to get to solutions, but let's hold on to those three words. How do we help people release the burden? So, we're going to get into individual and institutional strategies. We're hoping that when we get to the Q&A, our audience is, I know, going to have lots of wonderful, effective strategies to share as well, so in the first slide, we go through four major categories of strategies. Dr. Charles Nikita and I came up with these four categories. Obviously, there are probably many other effective strategies. In medicine, I think the first place that you have to start is you have to recognize that there's a problem before you can go about thinking about strategies, so for the first strategy, it's recognition for yourself and for those of us who are observing or happen to be a bystander of a microaggression. The second strategy, which is definitely in the bailiwick of mental health providers, is reflection and processing the information. The third is microaffirmations. This has been viewed as a potential antidote to microaggressions, and then finally, when we're looking at sustained change, institutional change, how do we really work together to create a plan for change, and we'll go through some of that as well. In the next slide, we'll start with recognition. The first step is being aware of microaggressions. That's why we spent a significant amount of time in the beginning of this presentation talking about microaggressions, sharing stories with all of you, and having you be aware of the different forms. It's so important to know about the microaggressions that are perpetrated against you, but also the ones that you perpetrate. You know, I give this talk so many times, and I've learned it from Dr. Pierce himself, and yet, when it happens to me, I have to call Dr. Childs or a colleague of mine and be reminded that, in fact, it is a microaggression, so I say this because when you're actually experiencing something as painful as a microaggression, you may not be so familiar, so if you have somebody call you and they're trying to describe what happened, don't be surprised if it's because it's so overwhelming and so shocking, as Nikita said in some of her stories, that it's not so obvious, and the more we have this topic in medical literature, in medical grand rounds, and in opportunities like this, the more we'll all be aware of it. It's also important to understand that there are other strategies, such as upstander recognition and self-respect, and the next slide is some pictures of upstander responsibility, and Dr. Childs, I'll let you take this one. Dr. Parrack, I love the term upstanders versus bystanders. This is so important, and this is my favorite slide. For all you guys who can't see, in the upper hand corner on the left side is a young kid with a holding a sign that My Black Friend Matters, so Black Lives Matter, from kids to the demonstration by the Asian group, from the women, and also young Americans, so Black lives are important. Be an upstander. Be active in part of the solution. It's very important to take a stand. Great. Thank you. I love this slide. I love the pictures. I want to put a plug in for bystander. I certainly believe that we need more upstanders. I also know that for some people, part of being a bystander is that it could be triggering to observe a microaggression experience, and so that sometimes people who don't speak up, it's because they have something that they're experiencing in this process. I've heard many countless people, patients, people I've supervised, myself, that I choose to be a bystander maybe in that moment but find myself later supporting somebody, and it's because that moment could be very triggering. I've also heard people say that trying to be more of an upstander helps them from having a vicarious experience, and that we know, certainly the trauma literature is really significant in this, that you can experience trauma symptoms just by observing, and so some people prevent that by becoming more of an upstander, but certainly we're definitely advocating more people, if they can be, and we appreciate if they can't, to be upstanders, and bringing more recognition and support and releasing the burden of the recipient of a microaggression. Next slide is our third strategy. It's self-respect. Nikita, do you want to go through this example? Yes, so in 2012, we had the presidential debates between Mitt Romney and President Obama, and after one of the debates, political commentator Ann Coulter made the comment, quote, I highly approve of Romney's decision to be kind and gentle to the retard, and she was referring to President Obama. And in response to this, Special Olympics athlete John Franklin Stevens said, being compared to people like me should be considered a badge of honor. No one overcomes more than we do and still loves life so much. I do process information more slowly. It is taking me all day to figure out how to respond to your use of the R word. Find a friend you haven't met yet, and we talked about how this could be under upstander responsibility because the comment made by Ann Coulter was referring to President Obama. But since John Franklin Stevens took this comment to heart and he still had the self-respect to stand up and speak out, it also falls under self-respect. And I just love the response. It's so elegant, so powerful. Again, we're going to talk about reflection process, which is within the strength of mental health providers. It took him 24 hours, but he took the time he needed to come up with a response that demonstrated self-respect, but also being an upstander. So I think it's a great example, and thank you, Nikita, for sharing this. We have another example of self-respect as well in the next slide that Dr. Childs is going to go through. Well, thank you, Dr. Allright. This is an image of the LA Clippers, and I'll remind you of the story. And I think it was probably 2014 or so, Donald Sterling, the owner of the LA Clippers, had made some disparaging remarks about African American men, and these remarks were recorded on phone. And he was talking to, at that point, his mistress, and he was making some comments about the African American athletes. And in that conversation that was widely publicized, it was deemed, obviously, very inappropriate to the point where the NBA banned him for life from any NBA activity, including being an owner. Now, it was very interesting, the story about Donald Sterling. Donald Sterling, actually, his original name, Donald Tokowitz, and he decided to change his name at an early age in the 60s because he felt that would give him a financial advantage. So at this particular game, the athletes decided to turn their jerseys inside out as a form of protest, and also as a form of self-respect. In addition to looking at the makeup of the team, this was also a team that was coached by one of the few African American coaches in the league at that time, Doc Rivers. So it's a very important moment in sports. Following this game, the Miami Heat, which was the premier team at the time, also turned their jerseys inside out as a form of protest. So I think the show of self-respect from the NBA was very important at that time, and this imagery is also very important. Thank you so much, Dr. Childs. I love this on so many levels, for all the things that you talked about, but you and I also give a lot of talks on collaborative negotiations, and in negotiations, there's a term called BATNA, Best Alternative to a Negotiated Agreement, which is basically your plan B, plan C, what you do if you are in a tough situation. And so many times, minorities, people who are underrepresented or minoritized groups will just leave a situation, and that might be the right thing to do. I mean, the story of Dr. Ann Nicole Jones is an example of leaving the University of North Carolina and going to her BATNA, but I love this because it's an example when you work together with other people, allies, upstanders, you come up with a way to respond to the microaggressions or the macroaggressions or systemic discrimination. You know, these are young men who I think want to play ball. They've got their fans and they've got their family out there. Again, mostly, they just want to play ball, and they've got to get that income, and their owner is clearly inappropriate, a racist, discriminatory, and so this allows them to still play the game, be there for their fans, and still say, that's not okay to their owner. So what an elegant response, both of these examples are just great examples of how you show self-respect, and I'm sure there's a lot behind the scenes that brought them to this point, and working together with other people, you can really come up with a way that allows you still to be in the game, figuratively and literally, and still say, this is not okay. So thank you both, Nikita and Dr. Charles, for sharing the story. So our next strategy is about reflection and process. I will say that as a psychiatrist, you sometimes need more time to process something than other examples, and you should feel comfortable taking the time to do that reflection and that processing of information, and during this reflection and processing time, reality tests, build your resilience, and take, again, as much time as you need to process. The next slide talks a little bit more about reality testing. Ask yourself some of these questions. Are you, or is that person that has approached you, are they having a bad day? My first inclination when anybody is approaching me is to ask them more questions, and the way that Nikita asked more questions of Ava and Nikki, and it shouldn't be you telling somebody who's sharing with you a potential microaggression that they had a bad day. Let them get there if, in fact, that's true. I find that in my work that almost 95% of the time when somebody is sharing with me an experience, I am telling them, no, you're not paranoid, no, I don't believe you had a bad day, what you just explained to me is a microaggression, and the exception really might be more that you're having systemic discrimination, not even micro. It's so important to share your experience with somebody in your network and find a constructive person, and maybe in the meantime, take as many as you can. It could be also very therapeutic for you, but also will help you recover the experience and the story when you're ready to share that with somebody. Next slide is an example of building resiliency, so as you're in this period of reflection process, as you continue to build your networks, your supportive networks, it's one of the reasons that when we had all of our fellowships at the American Psychiatric Association, we really wanted to put all the residents in training who had this incredible fellowship opportunity together. We were hoping that they would be able to lean on each other and to share their experiences with people who were probably at risk of also experiencing microaggressions and could help them walk through it, and they were part of different institutions, too, so that would make it also easier sometimes to share. I cannot thank organizations like the American Psychiatric Association for putting together this kind of webinar and having it widely distributed, so beyond this presentation, it's going to be taped and be available, and I'm starting to see microaggressions in surgical ground rounds and various other specialties. The American College of Cardiology is putting together a webinar on microaggressions during Black History Month, so there's just so many organizations that understand how important this is, not only from an educational perspective, but the solutions that we're talking about are really part of the training. Mentorship is important. I'm a big fan of finding mentors outside of one's organization so that they are really committed to the mentee and to helping you, and sometimes that means leaving the organization. Sponsors are really critical, people who can really open doors for you so that you can have another perspective, another opportunity away from the environment that you are in, and this is particularly true for, and I'm going to lean on you, Dr. Childs, here for some of your experiences, but sometimes residents feel stuck, right?, because their residents are in a training program, and this is where having an outside mentor or sponsor is incredibly important for them to build their resiliency. And also, thank you, Dr. Powerak, and it's also very important to understand that these things come from the top. It's the direction. It's the culture that you set, so it's very important to have that support, and some of the work that you did when you were at the APA, actually, I remember a lecture actually coming over to the APA when you were there to give a lecture, but having the opportunity to know that you're not alone and that there are other students and residents and faculty that's been through exactly what you're going through, so I think that support network is also super, super important. It brought a smile to my face when I asked Nikita to tell us a little bit more about Ava and that she was a member of the Black Student Union, and I think how important is something like that in terms of building the supportive network. You know, I would say also another important part of building resiliency, and all of us who've experienced life know that there are times when you need to focus on yourself and be okay with that. Self-compassion, directing more time and effort on yourself is really all part of resiliency. You know, we know about in the airplane analogy, when the oxygen mask comes down, putting it on yourself first is sometimes really the first step, so certainly we could go on and on about resiliency, but a very important topic, especially in microaggressions, and for people who are at risk of daily microaggressions, we cannot overstate this importance. And then the final slide in this section is taking time to process, building self-awareness around microaggressions, strategies. I do call Dr. Childs, he's usually my first person, I have him on speed dial. There are also other people that you need to talk to, to get a different perspective that can help you build strategies. I find that particularly true when we're looking at institutional and organizational strategies, how important it is to have multiple conversations with many people. You're constantly improving your understanding. I'll give a shout out to Dr. Childs about another thing. He never wants to give a talk on microaggressions the same way. We practice, we think about the examples, and again, we've done this for so many different groups and community groups and specialties, and the idea is we also want to really understand, and it gets to be more and more robust. I cannot tell you how much we've learned having a 17-year-old join us. Some of it has been sad to see some of the same things that Dr. Childs and I see in medicine also happening in childhood, but also just the strategies and the optimism has been really wonderful to hear. So again, having those networks of people that you can run this by, if you have an opportunity to go to a microaggression lecture, never miss that opportunity, because I always want to learn, so I find myself gravitating to those talks to just hear about other perspectives. We're also spending time in this period of thinking about the next steps for you. Do you want to add anything to this, Dr. Childs? Dr. Primark, I really appreciate being here, and I also appreciate Nikita being here. One of the things Dr. Andrew Young used to say, and we have the opportunity to see him here at Morehouse School of Medicine, but it takes a generation to make a sustained change, and it's so important to have someone that's young and aggressive and that's courageous to stand up and participate in these types of events, so I appreciate her being here. Thank you. So the next slide is our third strategy with microaggressions. Dr. Mary Rowe, similar to Dr. Gerald Wing Sue, built upon the work of Dr. Pierce, and she actually surmised that if there was something like a microaggression, which is small, innocuous, and yet had the capacity to cause so much pain, couldn't there equally be something so small and subtle that had the potential to create such positive change? And so microaffirmations defined by Dr. Rowe are subtle or small acknowledgments of a person's value or accomplishments. It's really important if you're going to microaffirm to make sure that in the process of microaffirming, you are not then microaggressing somebody else. So an adage to this term, she described it as that you may refer to one person, but that it in itself should not imply an advantage, and hence a disadvantage to somebody else. And the next slide shows some examples of microaffirmations, so actively listening. We see this all the time, definitely pre-pandemic, we'll see this post-pandemic, people giving lectures. And so, you know, how important it is to pay attention to the person who's giving the talk. So for example, let's say if Nikita is in the audience, Dr. Childs and I are giving the talk, and every time Dr. Childs speaks, she looks at him, so she's actively listening, microaffirming him, but every time I speak, she gets on her iPhone. Well, she might be microaffirming him, but then she's microaggressing me. So it's really important to microaffirm and to do it in a way that, again, that you're not putting that one person at advantage and somebody else at a disadvantage. So active listening is a classic example of microaffirmation, making eye contact with persons of color. We see this in reverse so often. I see this on team rounds, or I hear from trainees and physicians of color how oftentimes the attending won't look at them as having the answer, they'll look at their white counterparts as having the answer. Having on-the-spot praise is an example of a microaffirmation. Black Lives Matter. Now, Dr. Childs gave an example of upstanding responsibilities for people who are actually out there demonstrating. But another example of microaffirmations is wearing a Black Lives Matter shirt. So you are affirming certain groups, black and African-Americans, and that's an example of microaffirmations. Dr. Childs, do you want to add anything to that before we get to our final strategy? I think it provides, you know, microaffirmation provides value to the person. And it provides the level of respect for that person to participate in the dialogue. So microaffirmations are very, very important, I think, in my opinion. I will share a story with you that is very powerful around microaffirmation that also clicked for me how subtle and yet powerful this is. I was attending a women's conference. And because I was flying from one event to another, I got there at 6 o'clock in the morning and the conference was going to start at about 8. And when I got there, the course director was in the room and we were in the coffee area. And this happens, I know, for many people. You walk into a conference and you don't know who you'll know. And so you just want to go get your coffee or breakfast and just sit in a corner. And when I went to go get my coffee, the course director said, you're Dr. Perak, right? And I said, yes. And I immediately didn't recognize her. And she said, you know, I'm Dr. Silver. Why don't you join me at my table? And I said, oh, thank you. And so she and I were having a cup of coffee together. And then I was watching as other people were trickling into the room. And every person that came in, again, the same awkwardness that I showed, you know, grabbing their coffee and trying to sit at a table by themselves. And she'd say, oh, please join us. And what is your name? And we kept doing this. And then I was really interested in knowing what she was going to do when the table was sort of brimming with too many people. And then finally, at that point, she asked about two or three of us if we would move and start another table. And what was really powerful was that it was subtle, but you felt a sense of belonging, which is the term you used earlier. And how contagious micro affirmations are in the same way that we know that microaggressions can be contagious. So again, small events that are so powerful that could really be life changing for people. And really an example of how modeling is so important and modeling micro affirmations to really lead to, you know, widespread change. So the next slide. Thank you. And the final strategy is the plan for change. And this is where you're really looking at significant organizational change, sustained change. And the first step in any kind of step that you have made that you want to see change. And again, you had a reflection process earlier. And at the end of that reflection and process stage, you're deciding whether or not you are going to change something. Now in the Dr. Pierce story, it was an airplane ride, not going to see anybody again. He chose not to do anything. Whether or not that was worth it to him is a question I never asked him. But you know, again, you have time to decide earlier if you're going to make a plan for change. But if you are, the first step is assessing the potential for change. The second is really working with your networks, with the right allies to implement and sustain change. And then looking how you actually change the organizational culture. So let's start with assessing the potential for change, which is in the next slide. These are some rhetorical questions for you, the person who has experienced the microaggression or microaggressions. Is it worth it to you to say something to the perpetrator? Is it worth it to your health to say something or not to say something? And is change possible? And if so, is it possible right then and there when the experience happened, or can you come back to it later so that you have given yourself the time to process and reflect? And we go back to Dr. Childs' early negotiations literature. Is it better to walk away like Professor Nicole Hannah-Jones or to do something? And this does come from some of the negotiations literature, Getting to Yes is a classic book. by the Harvard Negotiations Project and how important it is sometimes, particularly for women and underrepresented groups, minoritized groups, to just walk away from toxic environments. The next slide gives examples of issues that you need to consider. This is not all the issues, but certainly some of the most important issues for you to consider before you talk to a perpetrator, somebody who has micro-aggressed you. Can you have a frank discussion with a person who has hurt you? So, I keep thinking about Ava and the way Nikita told the story. It was a friend that made these comments. So, in that case, maybe Ava feels like she can go back to this mutual friend. Second question you need to ask yourself, do you feel that the perpetrator is well-meaning? Also, do they have the capacity for insight? Can they reflect on their behaviors? Do they have the capacity to understand that they might have done something or they have done something that would hurt somebody else? And then finally, you need to ask yourself, what are the consequences to you if you decide to have the conversation or if you decide not to have the conversation? For my residents and my trainees, they may not have another option. So, you need to be thinking about all of these and other things before you progress into the next stage. I don't know, Dr. Shells, if you want to add anything or Nikita, if you want to add anything. But these, again, are just some of the questions that you need to be asking yourself. I think all of these questions are very, very important. And like you said earlier, getting to yes and whether you're going to address these issues. But Dr. Primarock, I think it's also very important to getting to no. Just like Kohana Jones, she said no to the University of North Carolina. Standing up for her self-respect and moving on to an institution that valued her as a professional and also as a thought leader. So, sometimes you don't want to split the difference, as Chris Voss would say. You want to get to no. Right, I love that, getting to no. You know, Professor Hannah Nicole Jones understood that the institution was not insightful enough to know what they had actually done. And so, she risked having a lifetime of microaggressions if she had stayed in that institution. I think we could probably agree to that. So, the next slide just gives some sample questions. Again, this is within the bailiwick of mental health providers. The kinds of questions, if you choose to have a face-to-face conversation with a perpetrator of a microaggression, asking open-ended questions. Help me understand why you said or why you did what you did. It's important to use I statements. I was hurt by that, rather than, Dr. Childs, you microaggressed me, because then you might get somebody in a position that then becomes very confrontative. And you're trying to help yourself understand why they did what they did, and also give them an opportunity to apologize, to understand what it is that they did, so that they don't do this to other people. And without blame, start off by explaining what the situation or the experience felt like for you. And then give the perpetrator a chance to respond. We know that there are some people that may not be able to respond in that moment. So if you are the perpetrator listening to this presentation, if you don't have words, you're shocked by somebody calling you a microaggressor, that somebody has said to you that you've done something that's been hurtful and it's been experienced as a microaggression, say something like, I need time to think about this. Thank you for that feedback, and I will get back with you. And then get back with that person. So recognize that people may not be able to respond in that moment, but please, it's so important to have that dialogue and to be able to acknowledge that you could have caused so much pain to somebody. Really important. The next slide looks at implementing sustained change. And Dr. Childs, you're at a preeminent medical school. You're at, you know, HBCU. You're at Morehouse School of Medicine. They do a lot of things really, really well, and they actually prevent microaggressions from happening. They create environments that are incredibly affirming. Can you take this slide and actually the next few slides, please? Well, I think it's important, just like we mentioned, to be proactive, to leadership starts at the top, to set the tone and set the culture for sustained change. Like I mentioned earlier about Nikita and bringing the next generation to have them understand the importance of these issues, to be the voice of change, critically important. And in the next slide, we have some strategies around organizational change. So one of the things we're going to do is brainstorm ways to make those structural changes, have buy-in. A critical example is as chairman of the Department of Surgery, you want to have active participation from the entire group, and you want to set out strategies that honor and respect diversity of opinion. So it's a leadership, it's an active leadership to make sure that you can make these sustained changes. Great. And in the next slide, it's really about creating affirming environments. I think the key thing, again, I'm going to look at you because Morehouse School of Medicine and our HBCUs do this, their approach is consistent. Yeah, imagery is everything. I mean, you know, the visual we had with the LA Clippers, super, super, super important to show that matter of self-respect. The self-respect showed by the individual within culture, very, very important to changing the environment. Some of the things that we're doing today with Black Lives Matter is very, very important to an affirming environment. Being receptive, being open, leading by example, all these things are critically important. Are you willing to be a sponsor? But will you take on elementary school and make a difference? Will you take on a pathway program and make a difference? All of these things are very important to us here at Morehouse School of Medicine. We think it should be important for everyone. Great. And then our next slide is really an example of affirming environments. There's a social campaign out there that walls do talk. And how important it is for those of us who are leaders in an organization, certainly the chair of a department, the president of a hospital, a community setting, what do you have on your walls? Again, this is so incredibly important. I hear trainees tell me all the time that they've gone to an interview and they really liked the institution, but as they were walking down the halls, they noticed that there were paintings and pictures of people who just didn't look like them. This is an example of Tammy Duckworth, the senator from Illinois, who is wearing red, she's in a wheelchair, and she's standing next to the powerful Capitol. And how important it is that these kinds of images are for people, and particularly for this next generation, which is one of the most diverse generations. We know that millennials will decide on whether or not they'll go to a job based on their diversity, equity, and inclusion commitment. So, so incredibly important to be thinking about your walls and what kind of messages are you sending, not only to people who may be wanting to join your organization, but your visitors? What messages are you sending to people every day without even opening your mouth? So, really important to be thinking about the environment around you. We're gonna end with this next slide, a picture of Dr. Chester Pierce. We've talked about organizational change and how important it is for people to strategize when they're looking at sustained change and changing an environment that is affirming. In 2017, many of you know this, the American Psychiatric Association renamed its Human Rights Award to honor Dr. Chester Pierce. My understanding is that there was a conversation at the World Psychiatric Association in 2016 with some leaders in the American Psychiatric Association, like Dr. Elliot Sorrell, Dr. Constance Dunlap, share that story with me, and she's always way too modest. And I think she's listening to this presentation, but I'm sure she had also a lot to do with it. I know Dr. Alpha Stewart also was a driver, and I wanna thank all of those folks who really got together. It's a organizational level, strategic change, and so important for the generations to come, not only for my generation, Dr. Chow's generation, for Nikita's generation, the next generation of physicians and health providers. It's so incredibly powerful. And with that, our next slide and our final slide is really just important takeaways. I'm sure there were many takeaways for all of you. Nikita, do you wanna go through some of the highlights that Dr. Childs, you and I came up with for this presentation? Yes, the first one is that microaggressions are obviously ubiquitous and harmful. We saw that with the reactions to the recipients of the story shared by Dr. Perak, Dr. Childs, and myself. Secondly, one of the most insidious qualities of microaggressions is that the recipient may not know if the act was conscious or unconscious. The story that Dr. Perak shared about Dr. Pierce, he was sitting on that plane ride and he was thinking about that one action for the rest of the flight. Certain groups are at risk of a lifetime burden of microaggressions, which can cause mental health consequences. And there are effective strategies that you can and should lean on your networks to help you with. Thank you so much. And if we could go to the next slide. On behalf of the panelists, we wanna thank the American Psychiatric Association and Morehouse School of Medicine for the opportunity to really highlight this very important talk. We also wanna thank all the learners and participants who joined in today. You know, when I was the director of the APA, APA Foundation Fellowships, and Dr. Childs had actually joined me on a couple of occasions to do a talk on microaggressions, very recently, one of my SAMHSA-funded minority fellows sent me a direct message on Twitter. It was a picture of her and I being at a talk while she was a fellow, and now she's giving this talk. And I just thought that was so powerful that these talks really will enable other people to pay it forward. And so for that, I'm really grateful, again, as I know as Dr. Childs and Nikita, to the APA and Morehouse School of Medicine. We'd like to dedicate this presentation to Dr. Chester Pierce in the next slides of oil painting of Dr. Pierce. It resides at Harvard. As I mentioned, Dr. Pierce was a professor of psychiatry, but he was also a professor of medicine and education at Harvard. And this painting is a picture of him standing at the Ether Dome at the Massachusetts General Hospital. It's where we have our ground rounds in the Department of Psychiatry. And we dedicate this talk to Dr. Pierce. And our final words for you are in the next slide. And Nikita, I thought maybe you could leave us with these powerful words. Yes, we wanted to leave you today with a quote by Mahatma Gandhi. He said, you must be the change you wish to see in the world. It's an incredibly well-known quote, but nonetheless powerful. And we hope that this presentation has inspired you to be a change agent when it comes to microaggressions and that you're able to learn more and teach others. Thank you so much. And we will go to the next slide, which is questions and answers. And while we're waiting, maybe I could ask my colleagues. Can I just, I apologize. Can I just say one thing before we get to the questions and answers? Sure. I am so, so proud of you. And the courage that it took for you to stand up for your friend, it's amazing. And I know you have a very bright future and I am so proud of the work that you're doing. And I'm sure your friend is also very, very proud that you are an upstander. And you're taking on these very important issues. So thank you so much for being here. And Dr. Prorok, thank you also for inviting me. Always a pleasure. Nikita, do you have any final thoughts as we wait for the questions to pop up? I just wanted to say thank you to Dr. Childs and Dr. Breck for letting me to participate in this. I have learned so much, especially about strategies and ways to be a better ally to the people around me. So thank you. Thank you both. So we will go to the questions. And Ms. Harris, if we could just go to the next slide. I think there's one more. Oh, sorry, Dr. Childs. I think this was your slide. Okay. So let's see. I do have a question for you, Nikita. There's one that's popped up. How do you plan on taking this experience and paying it forward? I think when it comes to tackling big issues, for me, the best way is to start with people closest to me. And so for me, that's my school community. So I hope to write an article in my school newspaper and be there for the people around me to help teach and also help the students and faculty learn about microaggressions and the strategies to help. Hmm, I love that. It's kind of sort of like being a doctor, you know, taking down these words, literally, that each of us can be doing work in our own communities or at the one-to-one level. Dr. Childs, a lot of questions are coming in for you. Oh, all right. Organizational strategies. Why does Morehouse do this so well? I could think of a lot of reasons, but why does Morehouse do this well? Well, I think we are to change. We are to change agents. That's what we're all about. We value everyone here at Morehouse School of Medicine. And I think it's so important to lead by example. And not just our school would be that example to lead the country in this type of issue. So I think it's very important that Morehouse take on that challenge and lead by example. Okay. So I think we had more questions about the mission and vision statements within an HBCU and particularly at Morehouse School of Medicine. I thought that's an incredible question. If you could share that, that would be great. Yeah, I think there's a lot of different ways to think about looking at diversity and healthcare challenges at different institutions. But one of the things that Morehouse School of Medicine strive for is one, to train the next generation of learners and also to be the lead in the area of healthcare disparities in this country. So those are the things that are core to our mission and core to our vision here at Morehouse School of Medicine. Now, I understand there's a question, another question, but I don't see any more questions. Dr. Childs or Nikita, can you help me with the legend on the right? I saw a couple of those questions when I just shared, but I'm not seeing any more. So the one question that I'm seeing is in regards to some of the information that was shared at the beginning of the presentation when we were going through the exercise. The question is, isn't there a subtle boundary violation when micro affirmations lock into a micro invalidation where perceived as false praise? Invalidation where perceived as false praise, how to protect against this? Ms. Harris, I missed a part of the question. It got blurry for me a little bit. Something about, was it the question with Ava? Is that what we're referring to? Yeah, it's basically what the, it sounds like the learner is asking is how do we basically view micro affirmations and how do we prevent them from overlapping and being confused with micro invalidation? And how do we protect against it? Great, so I think that's a great question. And micro affirmations, you really need to intentionally practice, I think. One is you've got to be authentic about it. I think that's a critical aspect of it. You don't want to micro affirm somebody. I think that was the example that we were giving and then have somebody else next to that person and invalidate them as you're micro affirming somebody else. So it's usually when there's two people in the room or more than one person, you don't want to micro affirm one and then micro invalidate or micro aggress the next person. Sometimes it's better just to like, for example, look at everybody in the room and make eye contact with every single person and say, welcome, not just focus in on just one person. If you're in a situation where there's more than one person. I hope that answers the question. And I know Dr. Childs or Nikita want to add to that, but important question. No, I agree. So I think that certainly there will be ways that you can reach out to me or Dr. Childs or Nikita if you have further questions. We'll go to our final slide and I can take you through how to claim credit. Again, you might just want to take a quick picture of this, but like many of the presentations that you have participated in, you can go to the learning center at psych.org and you can click on this particular event and claim credit. Want to thank you all so very much for tuning in on behalf of Dr. Childs and Nikita. We want to wish you a really good day. Thank you so much again. Thank you. Thank you. Bye. ably

Microaggressions

Strategies to Overcome Prejudice

Dr. Ronna Parekh

Dr. Ed Childs

Ms. Nikita Natyal

American Psychiatric Association

Mental health

Physical health

Upstander responsibility

Self-reflection

Microaffirmations

Institutional change