RESUMEN

Amidst a national youth mental health crisis, comprehensive school mental health systems offer an opportunity to promote positive mental health for all students. To advance health equity, schools benefit from a culturally responsive, antiracist, and equitable (CARE) framework to address the youth mental health crisis. This article describes how to integrate CARE practices within a multi-tiered system of support for mental health in schools. The strategies align with a trauma-informed approach and aim to enhance the capacity of comprehensive school mental health systems to promote positive mental health and well-being for all students.

Asunto(s)

RESUMEN

The US child mental health care system requires a revival and reimagination. We need to shift toward healing-centered models of care and prioritize access to high-quality mental health care through policy changes and resource allocation. Funding community-based programs that provide culturally responsive, antiracist, and equitable (CARE) systems is essential. Policies must be implemented to reduce barriers to accessing mental health services for underresourced communities. By prioritizing (CARE) over control, we can build a just workforce that is equipped to address the needs of a growing diverse population and ensure that all children and families can heal and thrive.

Asunto(s)

RESUMEN

Introduction: Recognizing the need for more opportunities to learn about health equity within military graduate medical education (GME), we developed a resident-led curriculum to introduce these concepts from a military cultural competency lens. The Impact of Racism on Health module focuses on structural racism and health disparities. Methods: This 60-minute module was presented to ear, nose, and throat (ENT) and pediatrics residents and fellows. It includes a case presentation of an adolescent with an asthma exacerbation, a large-group discussion about social determinants of health and structural racism, and a small-group discussion/debrief conceptualizing the case. Results: Thirty pediatrics residents and 15 ENT residents participated in this activity with a 46% and 60% pretest response rate, respectively. A two-sample Mann-Whitney U test showed statistically significant improvement (p = .005) in knowledge related to structural racism between the pretest (M = 0.5, SD = 0.3) and posttest (M = 0.7, SD = 0.1) knowledge assessments with a small effect size (r = 0.4; Z = 2.8). Discussion: We demonstrated that interactive teaching methods can be used to educate military GME trainees on the impact of structural racism on health outcomes for military health care beneficiaries. Understanding the role of structural racism in the context of military health care using curricula that highlight military-specific health disparities is essential to understanding the role of the military physician in systemically addressing health disparities.

Asunto(s)

RESUMEN

Introduction: Resident physicians frequently experience bias at work, with patients and families often being the source. Women and other trainees underrepresented in medicine are disproportionately impacted by these negative experiences, and experiencing bias contributes to resident physician burnout. Unfortunately, many resident physicians feel inadequately prepared to respond to bias. Methods: We developed a 45-minute, peer-led, case-based workshop that equipped trainees with tools to respond to patient-expressed bias. Our toolkit centered on resident physicians by including an assessment of the trainee's emotional well-being, a team-based response, and an embedded debrief. The toolkit provided resident physicians with possible responses to bias directed towards themselves (bias-towards-self) or bias directed towards others (bias-towards-others). Surveys were administered pre- and postworkshop to assess change in participants' comfort in responding to patient-expressed bias. Results: Thirty-seven residents completed both surveys. The workshop significantly increased comfort in responding to bias-towards-self (p < .001; 95% CI, 1.00-1.50) and bias-towards-others (p < .001; 95% CI, 1.00-1.50). Discussion: We improved resident physicians' comfort responding to patient bias-towards-self and bias-towards-others through a toolkit and workshop designed specifically for trainees. The toolkit centers the resident physician perspective, incorporates clinical context, and embeds a debrief. Our novel approach situates the toolkit's teaching in a highly scalable, case-based workshop.

Asunto(s)

RESUMEN

OBJECTIVE: To qualitatively understand and characterize the experience of racism in outpatient pediatric healthcare settings from the perspectives of Black families. METHODS: We conducted focus groups with parents or guardians of Black children, recruited from academic primary care offices at a single pediatric institution. Focus groups were facilitated virtually by Black team members using an open-ended, semi-structured focus group guide. We analyzed focus group transcripts using iterative, thematic, inductive open coding performed independently by trained coders, with final codes reached by group consensus. RESULTS: We conducted 6 focus groups of 3 to 5 participants each and 1 individual interview, with 24 total parents. We identified the following themes: 1)"I just felt like we was a number": Black families perceived experiences which felt impersonal and lacked empathy; 2)"Why is the doctor treating me like I don't matter?": Black families perceived experiences with poor care, worse treatment; 3)Black families experience racism across socioecological levels when interacting with pediatric health systems; 4)Positive perceived experiences can guide improvement; and 5)Improvement will require antiracist efforts across the levels of racism. CONCLUSIONS: In this qualitative study, we found that Black families have had many poor pediatric experiences, perceive racism as affecting child health broadly across socioecological levels, and recommend a multidimensional antiracist approach to improvement. Our findings underscore the importance of elevating Black family voices in developing policies that prioritize antiracism and work to eliminate the harmful impacts of racism on child health.

RESUMEN

PURPOSE: The US medical education system has a long-standing history of omitting evidence and perpetuating false pseudo-scientific beliefs on the complex and nuanced relationships between race, racism, and health disparities. There is an urgent need to identify and address the historical influence of systemic racism on the current curriculum, organization, and culture of US medical education. The goal of this study was to understand Black women medical student perspectives on race and racism in current medical school training and their recommendations to inform anti-racist action in US medical education. METHOD: The authors conducted a critical qualitative study to understand the perspectives of Black women medical students on issues surrounding race and racism in relation to US medical education. To their knowledge, this is the first study to use qualitative research methods to understand current thinking on the need for anti-racist pedagogy in medical school education among Black women medical students in the US. RESULTS: The interviews revealed critical limitations in the teaching of race, racism, and racial disparities, including a lack of historical depth, continuity, and evaluation of this content; lack of actionable guidance to address racial disparities in clinical practice; and dissonance between emerging anti-racist content and national licensing examinations. The qualitative data yielded several anti-racist strategies and practices that can be implemented in US medical schools to redress historical curriculum limitations and better prepare future generations of physicians to care for marginalized populations. CONCLUSIONS: This study provides actionable feedback on needed reforms to redress US medical school curriculum limitations as it relates to race, racism, and racial disparities.

Asunto(s)

RESUMEN

A bystander to racial violence is conventionally thought of as someone who witnesses an overt act of racial oppression at the interpersonal level, such as police brutality. However, racial violence in health research, pedagogy, and practice often shows up more covertly, like through epistemic injustice, deficits-based framing, and racial essentialism. We aim to expand how we think about bystanders and perpetrators of racial violence within health institutions, and how antiracism bystander behavioral approaches can be deployed to intervene against such violence. Existing public health antiracism frameworks, such as the Public Health Critical Race Praxis and the PEN-3 Cultural Model, offer valuable constructs and processes through which health practitioners, researchers, and academics can disrupt racial violence. Such antiracism frameworks are well suited to provide individuals within public health and health care with the knowledge, skills, and efficacy to intervene as engaged bystanders against racism within their contexts. To illustrate how constructs within antiracism frameworks can be applied by bystanders in various health settings, we outline case examples of antiracism bystander interventions across three scenarios. The more bystanders there are within health institutions that are equipped with antiracism tools, the more likely normative behaviors uplifting White supremacy within these institutions can be disrupted and health equity can be actualized.

RESUMEN

The principles of social justice, equity, diversity, inclusion (JEDI) have received increasing attention in behavior analysis circles, but the conversation has largely centered on implications for applied behavior analysis practice and research. It may be less clear to researchers who conduct basic and translational research how JEDI principles can inform and inspire their work. This article synthesizes publications from behavior analysis and other scientific fields about tactics of JEDI-informed research. We organized this scholarship across five stages of research from developing the research question to sharing findings and curated sources for an audience of behavioral science researchers. We discuss reflexive practice, representation, belongingness, participatory research, quantitative critical theory, and open science, among other topics. Some researchers may have already adopted some of the practices outlined, some may begin new practices, and some may choose to conduct experimental analyses of JEDI problems. Our hope is that those actions will be reinforced by the behavior analysis scientific community. We conclude by encouraging the leadership of this journal to continue to work toward the structural changes necessary to make the experimental analysis of behavior just, equitable, diverse, and inclusive.

RESUMEN

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.

RESUMEN

Racism is embedded in the fabric of society at structural, disciplinary, hegemonic, and interpersonal levels, working as a mechanism that drives health disparities. In particular, stigmatized views of substance use get entangled with racialization, serving as a tool to uphold oppressive systems. While national health institutions have made commitments to dismantle these systems in the United States, anti-racism has not been integrated into biomedical research practice. The ways in which substance use researchers use and interpret race data-without engaging in structural racism as a mechanism of health inequity-can only be described as inadequate. Drawing upon concepts from the Public Health Critical Race praxis, QuantCrit, and an anti-racism research framework, we recommend a set of guidelines to help biomedical researchers conceptualize and engage with race more responsibly in substance use research.

Asunto(s)

RESUMEN

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.

RESUMEN

Introduction: Medical schools seeking to correct and reform curricula towards anti-racist perspectives need to address anti-Black forms of racism specifically and teach students critical upstander skills to interrupt manifestations of racism. We developed a course to teach preclinical medical students basic anti-racism competencies including recognition and awareness of anti-Black racism in medicine and upstander skills to advocate for patients and colleagues. Methods: In 2021 and 2022, we designed, implemented, and evaluated an elective course for second-year medical students (N = 149) to introduce competencies of anti-racism focusing on upstander skills for addressing anti-Blackness. We designed three patient cases and one student-centered case to illustrate manifestations of anti-Black racism in medicine and used these cases to stimulate small-group discussions and guide students toward recognizing and understanding ways of responding to racism. We designed pre- and postassessments to evaluate the effectiveness of the course and utilized anonymous feedback surveys. Results: Participants showed significant improvement in pre- to postassessment scores in both years of the course. The anonymous feedback survey showed that 97% of students rated the course at least somewhat effective, and the qualitative responses revealed five core themes: course timing, case complexity, learner differentiation, direct instruction, and access to resources. Discussion: This course reinforces upstander competencies necessary for advancing anti-racism in medicine. It addresses a gap in medical education by reckoning with the entrenched nature of anti-Black racism in the culture of medicine and seeks to empower undergraduate medical students to advocate for Black-identifying patients and colleagues.

Asunto(s)

RESUMEN

In this paper, as Black scholars, we address ways that interventions designed to promote equity in health can create pathways for coupling decolonization with antiracism by drawing on the intersection of the health of Africans and African Americans. To frame this intersection, we offer the Public Health Critical Race Praxis (PHCRP) and the PEN-3 Cultural Model as antiracism and decolonization tools that can jointly advance research on colonization and racism globally. We argue that racism is a global reality; PHCRP, an antiracism framework, and PEN-3, a decolonizing framework, can guide interventions to promote equity for Africans and African Americans.

RESUMEN

Introduction: Medical curricula implicitly teach that race has a biological basis. Clinical rotations reinforce this misconception as race-based algorithms are used to guide clinical decision-making. This module aims to expose the fallacy of race in clinical algorithms, using the estimated glomerular filtration rate (eGFR) equation as an example. Methods: We created a 60-minute module in consultation with nephrologists. The format was an interactive, case-based presentation with a didactic section. A third-year medical student facilitated the workshops to medical students. Evaluation included pre/post surveys using 5-point Likert scales to assess awareness regarding use of race as a biological construct. Higher scores indicated increased awareness. Results: Fifty-five students participated in the module. Pre/post results indicated that students significantly improved in self-perceived knowledge of the history of racism in medicine (2.6 vs. 3.2, p < .001), awareness of race in clinical algorithms (2.7 vs. 3.7, p < .001), impact of race-based eGFR on quality of life/treatment outcomes (4.5 vs. 4.8, p = .01), differences between race and ancestry (3.7 vs. 4.3, p < .001), and implications of not removing race from the eGFR equation (2.7 vs. 4.2, p < .001). Students rated the workshops highly for quality and clarity. Discussion: Our module expands on others' work to expose the fallacy of race-based algorithms and define its impact on health equity. Limitations include a lack of objective assessment of knowledge acquisition. We recommend integrating this module into preclinical and clinical curricula to discuss the use of race in medical literature and clinical practice.

Asunto(s)

RESUMEN

Nursing education holds a history framed in white supremacy and whiteness. Efforts to employ antiracist strategies have been hindered, largely due to an inability for faculty to acknowledge and hold accountability for racialized harms that occur within nursing educational structures. A nurse-midwifery program in the Pacific Northwest United States uncovered harm that impacted students and identified a need to respond and hold accountability. Guided by the framework of Transformative Justice, a truth and reconciliation process was implemented as a first step to better address racism within nursing and nurse-midwifery education. This paper describes the process to support other institutions in their work to address harms within nursing education.

RESUMEN

BACKGROUND: Race dialogues, conversations about race and racism among individuals holding different racial identities, have been proposed as one component of addressing racism in medicine and improving the experience of racially minoritized patients. Drawing on work from several fields, we aimed to assess the scope of the literature on race dialogues and to describe potential benefits, best practices, and challenges of conducting such dialogues. Ultimately, our goal was to explore the potential role of race dialogues in medical education and clinical practice. METHODS: Our scoping review included articles published prior to June 2, 2022, in the biomedicine, psychology, nursing and allied health, and education literatures. Ultimately, 54 articles were included in analysis, all of which pertained to conversations about race occurring between adults possessing different racial identities. We engaged in an interactive group process to identify key takeaways from each article and synthesize cross-cutting themes. RESULTS: Emergent themes reflected the processes of preparing, leading, and following up race dialogues. Preparing required significant personal introspection, logistical organization, and intentional framing of the conversation. Leading safe and successful race dialogues necessitated trauma-informed practices, addressing microaggressions as they arose, welcoming participation and emotions, and centering the experience of individuals with minoritized identities. Longitudinal experiences and efforts to evaluate the quality of race dialogues were crucial to ensuring meaningful impact. DISCUSSION: Supporting race dialogues within medicine has the potential to promote a more inclusive and justice-oriented workforce, strengthen relationships amongst colleagues, and improve care for patients with racially minoritized identities. Potential levers for supporting race dialogues include high-quality racial justice curricula at every level of medical education and valuation of racial consciousness in admissions and hiring processes. All efforts to support race dialogues must center and uplift those with racially minoritized identities.

RESUMEN

Community engagement has been named a research priority by the National Institutes of Health, and scholars are calling for community engagement as an approach to address racism and equity in science. Robust community-engaged research can improve research quality, increase inclusion of traditionally marginalized populations, broaden the impact of findings on real-life situations, and is particularly valuable for underexplored research topics. The goal of this paper is to describe lessons learned and best practices that emerged from community engagement in a multi-institution population health research consortium. We describe how a foundation was laid to enable community-engaged research activities in the consortium, using a staged and stepped process to build and embed multi-level community-engaged research approaches.. We staged our development to facilitate (a) awareness of community engagement among consortium members, (b) the building of solidarity and alliances, and (c) the initiation of long-term engagement to allow for meaningful research translation. Our stepped process involved strategic planning; building momentum; institutionalizing engagement into the consortium infrastructure; and developing, implementing, and evaluating a plan. We moved from informal, one-time community interactions to systematic, formalized, capacity-building reciprocal engagement. We share our speed bumps and troubleshooting that inform our recommendations for other large research consortia-including investing the time it takes to build up community engagement capacity, acknowledging and drawing on strengths of the communities of interest, assuring a strong infrastructure of accountability for community engagement, and grounding the work in anti-racist principles.

RESUMEN

In various European countries, the post-fascist nationalist and populist parties identified by Ignazi in the early 1990s 'silent counter-revolution' now hold power, at least as part of coalitions. The values they represent can no longer be described as marginal to the national conversations on identity, immigration and security, issues that revolve around racialized understandings of the social world. In recent years we have observed similar phenomena in the Americas and Asia (with the Trump, Bolsonaro and Modi regimes). Moreover, state actors and social movements have developed initiatives aimed at undermining and reversing any small-sometimes symbolic-progress made toward equality. Various attacks on academic concepts relating to racism in the UK, France and the USA, for example, are not isolated stand-alones but elements of a global pushback against such ideas, orchestrated and encouraged by the nationalist political right, working through media, government and funded civil society organisations. These discourses redraw national identity to portray antiracist work as unpatriotic and indeed threatening to the nation. One of the strands in France's long and fractious conversation about its colonial history and postcolonial present has constructed an opposition between republican values and Muslims. The American right's long war on racial equality has generated a campaign to eradicate 'critical race theory' from education. These two examples illustrate and identify common elements and specifics in a global trend whereby the concepts used by activists and social scientists to understand and frame struggles for racial equality are deliberately and strategically invalidated and vilified in the public domain, and ideologically produced as un-patriotic. I call this discourse 'anti-anti racism'. These efforts are part of wider campaigns, or 'counter acts', aimed at reversing progressive political gains from the last half century.

RESUMEN

Concomitant with a growing recognition of demographic shifts toward greater racial/ethnic diversity in the United States and widespread depictions of racial injustice, desires for increased racial/ethnic tolerance and inclusivity have been expressed in various sectors of U.S. society, including education, healthcare, and business. However, the literature on effective strategies and interventions for advancing anti-racism, or efforts to reduce racial/ethnic injustice, is minimal and underdeveloped. The family science field, characterized by rich theories on human systems and interactions, strategies for changing interpersonal dynamics, and the recognition that perceived knowledge is dependent on sociopolitical location, has much to offer the study of strategies to actualize increased racial/ethnic equity. The articles in this special section demonstrate potential contributions family science can make to the endeavor for racial/ethnic equity, through presenting theoretical, empirical, and practice innovations and findings steeped in the family science orientation toward addressing systems, cycles, and change.

Asunto(s)

RESUMEN

Racially ethnically marginalized communities in the United States are exposed to structural and interpersonal forms of racism that have harmful effects on their health, wealth, education, and employment (Centers for Disease Control and Prevention, Racism and Health. https://www.cdc.gov/minorityhealth/racism-disparities/index.html, 2021). Although a plethora of research exists outlining these harmful effects, research examining how youth from diverse backgrounds effectively combat racism is lacking. Emerging research demonstrates that families may play a key role in the development of critical consciousness and participation in anti-racist actions (Bañales et al., Journal of Social Issues, 2021, 77, 964; Blanco Martinez et al., American Journal of Community Psychology, 2022, 70, 278; Lozada et al., Journal of Black Psychology, 2017, 43, 493). Yet, many key family processes have not been examined in relation to youth development of anti-racist practices. The current study included a sample of 327 racially ethnically diverse emerging adults (Mage = 18.80, SD = 1.28, range = 18-25), and explored the association between ethnic-racial socialization (cultural socialization, preparation for bias) and youth critical consciousness (reflection, motivation, action) and anti-racist (interpersonal, communal, political change) actions, and how familism values impact these associations. Results found that ethnic-racial socialization was positively associated with all aspects of critical consciousness and anti-racist actions. Results also found that familism significantly interacted with ethnic-racial socialization to predict some aspects of critical consciousness and anti-racist actions, but not others. Implications of the findings and future research directions are discussed.

Asunto(s)