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PURPOSE: The need for specialized rehabilitation considerations to address racial health disparities and optimize functional outcomes such as participation in daily life for Black people with traumatic brain injury (TBI) has been acknowledged. This study uses anti-racism as an entry point for addressing institutional racism by examining what the experiences of Black survivors of TBI, rehabilitation providers, and family caregivers tell us about imagined possibilities for rehabilitation to promote Black futures. MATERIAL AND METHODS: A constructivist-informed narrative inquiry using critical race theory and in-depth narrative interviewing was applied across ten women and four men. Reflexive thematic analysis within and across groups of participants led to conceptualizing two main themes and five sub-themes. RESULTS: Conceptualized themes captured requirements for TBI rehabilitations' investments in Black futures: (1) the need for critical information and specialized educational supports and particular requirements for supporting participation in meaningful life situations, and (2) responsibilities of delivering rehabilitation care for Black service users. CONCLUSION: TBI rehabilitation must be tailored to the realities of living while being Black, integrate personal values, beliefs, interests, and equitable supports to maximize optimal functioning and participation if the goal of rehabilitation is community integration for all persons living with the impacts of TBI.

Rehabilitation care that challenges institutional racism is fundamental to meeting the unmet functional and participation goals of Black people living with traumatic brain injury.At the individual-level, investments in anti-racist rehabilitation for Black traumatic brain injury service users require attention to clinical encounters between providers and patients and specifically the importance of the therapeutic relationship.Organizational level changes include critical information and education about intersections of race and traumatic brain injury, supporting participation in meaningful life situations, and particular responsibilities for Black and non-Black rehabilitation providers to inspire recovery.Knowledge of the rehabilitation professions requires racial consciousness of the practices, protocols, and guidelines underpinning care and how these bodies of documents reinforce racial health disparities which have implications for training and practice.

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Nursing is renowned for its high ethical standards and is considered one of the most trusted professions globally, yet it has deep historical ties to Eurocentric and white supremacist ideologies. These entrenched ideologies in nursing raise significant concerns regarding equity, diversity, and inclusion within the profession as they shape nursing education, research, and practice. Western nursing institutions are deeply engrained in a system designed to center and uphold whiteness, which frequently serves to safeguard dominant groups in power while detrimentally affecting faculty from underrepresented backgrounds. Consequently, faculty members from underrepresented groups depart academia due to systemic racism and inadequate institutional accountability and support. To decenter whiteness in nursing, we have shared our experiences to underscore how systems of oppression marginalize underrepresented faculty in nursing academia.

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BACKGROUND: We report on our methodological experiences during an investigation of how institutional racism functions in healthcare. We found tension between balancing methodological rigor with the unanticipated consequence of interviewer burden. METHODS: Semi-structured interviews were conducted with patients. Interviews were recorded, transcribed verbatim, and qualitatively analyzed using thematic content analysis. Interviewers also participated in weekly debriefing sessions and reported experiences with patients. RESULTS: Interviewers repeatedly experienced negative encounters with white patients during interviews. Themes included privilege to avoid racism, denial of racism, non-verbal discomfort, falsely claiming Native identities, and intimidation. These experiences were most pronounced with Black interviewers. DISCUSSION: Interviewer burden may need to be a consideration taken up in a variety of research contexts.

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BACKGROUND: The recent push to "decolonize nursing" has become a critical movement to address institutional racism, but the term has circulated through nursing circles enough to risk becoming a buzzword. PURPOSE: This article clarifies "decolonizing nursing" by addressing the following questions: (a) How has "decolonizing nursing" been discussed in nursing research? (b) What specific projects have been implemented to decolonize nursing? (c) How has decolonizing nursing been related to health equity? METHODS: We conducted a scoping review and searched CINAHL, PubMed, and PsycINFO databases. A total of N = 56 records were included. DISCUSSION: "Decolonization" has referred to a range of ideas related to resisting Western ideals, legitimizing Indigenous knowledge, and repatriating land and territory especially to Indigenous and dispossessed communities. Few empirical studies have examined the relationship between decolonization or colonialism and specific health outcomes. CONCLUSION: Decolonization differs from other social justice initiatives. To clarify what decolonizing nursing means, researchers can engage with historical, interdisciplinary, and community-based participatory research. In turn, nursing research will understand colonialism's historical context, provide evidence that supports policies that protect Indigenous territory, and design clinical interventions that promote health equity for dispossessed populations.

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PURPOSE: Traumatic brain injury (TBI) is a chronic disease process and a public health concern that disproportionately impacts Black populations. While there is an abundance of literature on race and TBI outcomes, there is a lack of scholarship that addresses racism within rehabilitation care, and it remains untheorized. This article aims to illuminate how racism becomes institutionalized in the scientific scholarship that can potentially inform rehabilitation care for persons with TBI and what the implications are, particularly for Black populations. MATERIAL AND METHODS: Applying Bacchi's What's the Problem Represented to be approach, the writings of critical race theory (CRT) are used to examine the research about race and TBI rehabilitation comparable to CRT in other disciplines, including education and legal scholarship. RESULTS: A CRT examination illustrates that racism is institutionalized in the research about race and TBI rehabilitation through colourblind ideologies, meritocracy, reinforcement of a deficit perspective, and intersections of race and the property functions of whiteness. A conceptual framework for understanding institutional racism in TBI rehabilitation scholarship is presented. CONCLUSIONS: The findings from this article speak to the future of TBI rehabilitation research for Black populations, the potential for an anti-racist agenda, and implications for research and practice.

Critical race theory contributes to a comprehensive understanding of racism in the literature about race and traumatic brain injury (TBI) rehabilitation by asking how racism operates in the scholarship, including methods, analyses, interpretations, and conclusions.Applying a critical race theory lens in TBI rehabilitation has the potential to inform antiracist scholarship that holds important implications for critical rehabilitation research, practice, professional training, and policy.Implications for rehabilitation practice include opening up opportunities to address how race and racism shape rehabilitation outcomes to imagine different possibilities, programs, and futures for Black people with TBI with various communities of practice.

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BACKGROUND: Over two decades of research about traumatic brain injury (TBI) rehabilitation emphasized the persistence of racial health disparities in functional outcomes that disproportionately impact Black populations without naming or addressing racism as the root problem. Further, the experiences of Black people with TBI have yet to be documented and accounted for in scientific scholarship from the perspectives of Black persons in Canada. PURPOSE: This study intended to examine the rehabilitation narratives of Black TBI survivors, family caregivers, and rehabilitation providers and use critical race theory as a conceptual framework to understand how anti-Black racism manifests in those experiences. METHODS: Through critical narrative inquiry informed by a critical constructivist paradigm and a critical race theory lens, in-depth narrative interviewing were conducted with seven survivors, three family caregivers, and four rehabilitation providers. Data were analyzed using reflexive thematic analysis within and across groups of participants to conceptualize themes and sub-themes. FINDINGS: Themes captured how racism becomes institutionalized in TBI rehabilitation: (1) the institutional construction of deficient Black bodies, (2) the institutional construction of rehabilitation access, (3) the institutional investment in resisting and approximating whiteness in rehabilitation practice, and (4) the institutional construction of deficient Black futures. CONCLUSION: Study findings point to the dire need to ensure rehabilitation programs, services, and the delivery of care are not determined based on inequitable practices, racial biases and assumptions about Black people, which determine who deserves to get into rehabilitation and have opportunities to be supported in working towards living a full and meaningful life.

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Racial residential segregation has been deemed a fundamental cause of health inequities. It is a result of historical and contemporary policies such as redlining that have created a geographic separation of races and corresponds with an inequitable distribution of health-promoting resources. Redlining and racial residential segregation may have contributed to racial inequities in COVID-19 vaccine administration in the early stages of public accessibility. We use data from the National Archives (historical redlining), Home Mortgage Disclosure Act (contemporary redlining), American Community Survey from 1940 (historical racial residential segregation) and 2015-2019 (contemporary racial residential segregation), and Washington D.C. government (COVID-19 vaccination administration) to assess the relationships between redlining, racial residential segregation, and COVID-19 vaccine administration during the early stages of vaccine distribution when a tiered system was in place due to limited supply. Pearson correlation was used to assess whether redlining and racial segregation, measured both historically and contemporarily, were correlated with each other in Washington D.C. Subsequently, linear regression was used to assess whether each of these measures associate with COVID-19 vaccine administration. In both historical and contemporary analyses, there was a positive correlation between redlining and racial residential segregation. Further, redlining and racial residential segregation were each positively associated with administration of the novel COVID-19 vaccine. This study highlights the ongoing ways in which redlining and segregation contribute to racial health inequities. Eliminating racial health inequities in American society requires addressing the root causes that affect access to health-promoting resources.

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RATIONALE: Structural racism is a primary avenue for the perpetuation of racial health disparities. For Black Americans, both historically and contemporarily, the neighborhood context serves as one of the most striking examples of structural racism, with stressful neighborhood contexts contributing to the well-documented inequalities in psychological functioning among this population. OBJECTIVE: Thus, in this study, we adapted an intersectional-ecological framework to investigate the links between community stress and multiple dimensions of mental-emotional health for Black men and women. METHODS: Drawing on cross-sectional data from 842 Black Americans from the Milwaukee area, we tested both objective (Area Deprivation Index; ADI) and subjective (perceived neighborhood disadvantage; PND) indicators of community stress as simultaneous predictors of negative and positive affect and the odds of psychological disorder (depression, anxiety) in multilevel models, examining gender differences in these linkages. RESULTS: Results showed greater objective community stress was related to lower levels of negative affect for both men and women and lower odds of psychological disorder for women specifically. Greater subjective community stress was related to higher levels of negative affect and lower levels of positive affect for both men and women and to higher odds of psychological disorder for women specifically. CONCLUSIONS: Findings highlight the complex intersectional nature of the links between community stress and Black Americans' mental-emotional health. Specifically, findings demonstrate the pernicious psychological effects of perceived community stress and allude to Black Americans', particularly women's, active resistance and resilience to objective disadvantage, potentially through investing in social relationships in their neighborhoods.

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The history of racism in the United States was established with slavery, and the carry-over effect continues to impact health care through structural and institutional racism. Racial segregation and redlining have impacted access to quality health care, thereby impacting prematurity and infant mortality rates. Health disparities also impact neonatal morbidities such as intraventricular hemorrhage and necrotizing enterocolitis and the family care experience including the establishment of breastfeeding and health care provider interactions.

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Resumo Este artigo objetiva compreender a visão de equidade racial e as motivações para a abordagem da saúde da população negra na formação dos cursos de Saúde Coletiva, Enfermagem e Medicina de uma universidade pública brasileira, orientado na perspectiva negra da decolonialidade. Considerando o Racismo Institucional, é preciso investir nas interfaces entre os setores educação e saúde na formação de profissionais para o Sistema Único de Saúde. Trata-se de estudo de natureza qualitativa com abordagem do tipo pesquisa-intervenção, afirmando um compromisso social e político de transformação da realidade. Para tanto, foram realizadas oficinas com representantes dos Núcleos Docentes Estruturantes dos cursos selecionados. A temática da saúde da população negra tem sido trabalhada de forma pontual e descontextualizada, sem uma reflexão do racismo estrutural, das relações de poder e da formação socio-histórica brasileira, o que se distancia das diretrizes propostas pela Política Nacional de Saúde Integral da População Negra. Ao final, são sinalizadas perspectivas para a reorientação da formação em saúde, visando ao aumento da densidade democrática e da equidade racial.

Abstract This article aims to understand the view of racial equity and the motivations for approaching the health of the black population in Collective Health, Nursing, and Medicine courses at a Brazilian public university, guided by the black perspective of decoloniality. Considering Institutional Racism, it is necessary to invest in the interfaces between the education and health sectors in the training of professionals for the Unified Health System. This is a qualitative study with an intervention-research approach, affirming a social and political commitment to transforming reality. Workshops were held with representatives of the Structuring Teaching Centers of the selected courses. The theme of the health of the black population has been elaborated in a prompt and decontextualized manner, with no reflection based on structural racism, power relations, and Brazilian socio-historical formation. This creates a distance from the guidelines proposed by the National Policy for Comprehensive Health of the Black Population. At the end of this article, perspectives are identified for the reorientation of health training, aimed at increasing democratic density and racial equity.

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As racial influences on forensic outcomes are identified in every aspect of practice, scholars are exploring methods to disentangle race from its historical, economic, and attitudinal antecedents. Because jurisdictions vary in these influences, definitions and data may differ among them, creating inconsistencies in analysis and policy. This retrospective database review compared differences in racial outcomes among 200 pretrial defendants, 160 Black and 40 White, exploring a wide range of socioeconomic, clinical, and forensic influences before, during, and after hospitalization. Because of the tight relationship of socioeconomic factors and race, investigators hypothesized that it would be difficult to distinguish racial influences alone. Using a confirmatory approach to data collection and a statistical analysis based in logistic regression, only differences in referral for psychological testing were identified. Application of this method based on local demographics and culture may prove useful for institutions interested in evaluating racial influences on forensic outcomes.

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The American South has been characterized as a Stroke Belt due to high cardiovascular mortality. We examine whether mortality rates and race differences in rates reflect birthplace exposure to Jim Crow-era inequalities associated with the Plantation South. The plantation mode of agricultural production was widespread through the 1950s when older adults of today, if exposed, were children. We use proportional hazards models to estimate all-cause mortality in Non-Hispanic Black and White birth cohorts (1920-1954) in a sample (N = 21,941) drawn from REasons for Geographic and Racial Differences in Stroke (REGARDS), a national study designed to investigate Stroke Belt risk. We link REGARDS data to two U.S. Plantation Censuses (1916, 1948) to develop county-level measures that capture the geographic overlap between the Stroke Belt, two subregions of the Plantation South, and a non-Plantation South subregion. Additionally, we examine the life course timing of geographic exposure: at birth, adulthood (survey enrollment baseline), neither, or both portions of life. We find mortality hazard rates higher for Black compared to White participants, regardless of birthplace, and for the southern-born compared to those not southern-born, regardless of race. Race-specific models adjusting for adult Stroke Belt residence find birthplace-mortality associations fully attenuated among White-except in one of two Plantation South subregions-but not among Black participants. Mortality hazard rates are highest among Black and White participants born in this one Plantation South subregion. The Black-White mortality differential is largest in this birthplace subregion as well. In this subregion, the legacy of pre-Civil War plantation production under enslavement was followed by high-productivity plantation farming under the southern Sharecropping System.

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Resumo O presente ensaio tem o intuito de problematizar as iniquidades em saúde, a partir da análise da violência obstétrica direcionada às mulheres negras. Pressupomos que o racismo institucional é chave interpretativa importante para compreender a dinâmica de violências raciais. Adotamos como metodologia, para evidenciar o racismo enfrentado cotidianamente por mulheres negras nos serviços de saúde, a análise descritiva de duas reportagens publicadas no site do G1. Constatamos que o racismo é (re)produtor de negação de direitos, do não acesso aos serviços de saúde, da produção da morte e da não efetivação do Bem Viver para as famílias negras, e isso vem sendo colocado através da produção e reprodução do sofrimento, da violência e do racismo em suas mais diversas expressões. Nessa dinâmica, a efetivação da Política Nacional de Saúde Integral da população negra é mecanismo importante de enfrentamento ao racismo em saúde.

Abstract This essay debates health inequalities by analyzing obstetric violence directed at Black women. We assume that institutional racism is an important interpretive key to understanding the dynamics of racial violence. We adopted the descriptive analysis of two stories published on the G1 website as a methodology to highlight the racism faced daily by Black women in health services. We found that racism (re)produces the denial of rights, non-access to health services, production of death, and non-realization of Good Living for Black families, and this is evidenced by producing and reproducing suffering, violence, and racism in its most diverse expressions. In this dynamic, implementing the National Comprehensive Health Policy for the Black population is an important mechanism for confronting racism in health.

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Racial discrimination and racism are ubiquitous. These feelings and resulting acts of discrimination contribute to the mental illnesses among those who experience it and face it regularly. Although efforts have been made at international level to develop correct definitions and actions to mitigate and eliminate these acts in policies, reality remains very different. Racism is pervasive and can manifest in several, often-overlapping forms as it may be personal, internalised or institutional. The concept of personally mediated racism refers to deliberate social attitudes and behaviours, to racially prejudiced actions, to discrimination towards others according to their race, or devaluation, or stereotyping for the same reasons. Research has shown that discrimination and perceived discrimination contribute to mental ill health as well as poor physical health and poor wellbeing. Managing issues related to racism requires interventions at multiple levels from individual education and training, institutional responses and policy measures. All of these require appropriate funding.

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OBJECTIVE: Transforming the University of Southern California health care system requires that institutions and organizations position equity, diversity, inclusion (EDI), and anti-racism as central to their missions. The purpose of this administrative case report was to describe a systematic approach taken by an academic physical therapy department to develop a comprehensive antiracism plan that engages all interested and affected parties and includes processes for sustainable, long-term engagement. METHODS: Four strategies contributed to organizational change toward anti-racism: Holding Ourselves Accountable; Developing a Plan; Building Consensus; and Providing Education, Support, and Resources. The attitudes of faculty and staff about racism and anti-racist actions were assessed through surveys at the start of the process and after 1 year. Engagement in activities, meetings, and trainings related to EDI and anti-racism was logged for faculty and staff. RESULTS: From November 2020 through November 2021, several outcomes were achieved, including: making structural organizational changes; updating faculty merit review to include EDI; developing a bias reporting mechanism; establishing faculty development activities, resources, and groups; and implementing structured efforts to recruit a diverse cohort. Within that year, faculty and staff engaged in 99.32 hours of EDI and anti-racism trainings, workshops, and resource groups. Survey data showed persistent high support and commitment to EDI and anti-racism. Faculty and staff reported that they felt more equipped to identify and address individual and institutional racism and they reported risking their reputations to talk about race more often. Confidence in their ability to identify and resolve conflicts related to microaggressions, cultural insensitivity, and bias improved. However, their self-reported ability to identify and address structural racism remained unchanged. CONCLUSION: By approaching anti-racism as transformative rather than performative, an academic physical therapy department was able to develop and implement a comprehensive anti-racism plan with high support and engagement. IMPACT: The physical therapy profession has not been immune to racism and health injustice. Organizational change to become anti-racist is imperative for excellence and a necessary challenge to undertake if the physical therapy profession is to transform society and improve the human experience.

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Current and persistent racialized inequalities in the United States raise important research questions investigating the social structures and systems that underlie racist outcomes. Consequently, social workers are called to centralize race and racism in their research agendas and utilize critical race theories and methodologies to examine institutional racism. This study investigates the extent to which critical race frameworks are utilized in mainstream social work research. The researchers conducted a content analysis of three top-ranked mainstream social work research journals (N = 407) to determine the extent to which critical race theories and methodologies are utilized for the investigation of institutional racism. Findings demonstrate a dearth of critical investigation into issues of race and racism in mainstream social work research as well as the underutilization of critical race frameworks. In conclusion, researchers argue for a critical shift in mainstream social work research through utilizing critical race theoretical frameworks and methodologies.

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This article is a narrative and conceptual exploration of the journey towards practicing Indigenous allyship in an academic context. I begin by tracing a trajectory of coming to work with Indigenous peoples as a non-Indigenous, multiple migrant, and queer person of color situated as a therapist and educator in a Canadian academic institution's Faculty of Medicine and Health Sciences. Anti-racist and de/postcolonial theories and concepts abound to label my experiences of tokenization, yet they invariably fall short of the nuanced and complex ways that both reconciliation and oppression unfold in the everyday. Beyond critical theories that speak with certainty of structural violence, I trace my trajectory of coming to understand my work with Indigenous peoples within and for healthcare curricula and community development. I describe an intertextual practice of echopoetics that is trying to make sense of a world where both historical trauma and daily aggressions continually reproduce inequities, in order to reveal spaces of possible hope and healing. Yet, what seems to be happening in this echopoetics is a process of unbelonging from the multiple cultural and institutional narratives in my surround-at times including those that intend to liberate. Focusing on the negation-"non"-as a non-Indigenous/non-White person, I provide a reflection on how this practice cultivates an unbelonging that becomes both a political stance at the point of invisibility, as well as a lonely yet definite healing.

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Objectives: This novel critical transdisciplinary scoping review examined the literature on integrated care pathways that consider Black people living with traumatic brain injury (TBI). The objectives were to (a) summarize the extent, nature, and range of literature on care pathways that consider Black populations, (b) summarize how Blackness, race, and racism are conceptualized in the literature, (c) determine how Black people come to access care pathways, and (d) identify how care pathways in research consider the mechanism of injury and implications for human occupation. Methods: Six databases were searched systematically identifying 178 articles after removing duplicates. In total, 43 articles on integrated care within the context of Black persons with TBI were included. Narrative synthesis was conducted to analyze the data and was presented as descriptive statistics and as a narrative to tell a story. Findings: All studies were based in the United States where 81% reported racial and ethnic disparities across the care continuum primarily using race as a biological construct. Sex, gender, and race are used as demographic variables where statistical data were stratified in only 9% of studies. Black patients are primarily denied access to care, experience lower rates of protocol treatments, poor quality of care, and lack access to rehabilitation. Racial health disparities are disconnected from racism and are displayed as symptoms of a problem that remains unnamed. Conclusion: The findings illustrate how racism becomes institutionalized in research on TBI care pathways, demonstrating the need to incorporate the voices of Black people, transcend disciplinary boundaries, and adopt an anti-racist lens to research.

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Many victim service organizations are seeking to realign service delivery around principles of racial equity. Dismantling institutional racism is a complex, intensive, and long-term process. Therefore, despite this imperative from the field, our knowledge about how social service organizations can effectively advance anti-oppressive practice is limited. This study examined victim advocate perspectives on the role institutional racism played within their work and the supports needed to undo institutional racism within their organization. Six focus groups were conducted with a meaningful cross section of staff members (n = 53) across the organization. Semi-structured interview guides included questions in four domains: (1) racism within client work, (2) challenges to addressing racism, (3) effective solutions, and (4) helpful organizational supports. Transcripts were thematically analyzed using modified constructivist grounded theory methods. Two overarching themes, Identifying Institutional Racism in the Workplace and Advancing Anti-racist Practice, and six subthemes emerged from the analysis. Advocates identified that naming and becoming comfortable talking about race was essential. Further, they believed it was important to acknowledge the ways in which that racism was implicitly built into helping systems at large. Advocates explored how internalized racial stereotypes influenced interactions between black, indigenous, and people of color (BIPOC) and white advocates and their clients in complex ways. Advocates highlighted organizational efforts that supported ongoing personal reflection, the creation of an accountable community, and staff empowerment within the organization as being critical to advancing anti-racist practice. Some advocates also wanted to see the organization move further in the direction of standing with BIPOC communities, particularly around criminal justice concerns. Findings provide important timely insights into how institutional racism manifests within victim service organizations and what organizational actions encourage anti-oppressive practices and culture.

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