Hello and welcome, everyone. I am Jose Villarreal, Clinical Director of Behavioral Health at Erie Family Health Centers and Community Care Expert for SMI Advisor. I am pleased that you are joining us for today's SMI Advisor webinar. The topic is racism in Black mental health, unpacking implicit bias in counseling. Next slide, please. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based cares for those living with serious mental illness. Working with experts across the SMI clinical community, our efforts have been designated to help you get the answers you need for the care of your patients. Next slide. Today's webinar has been designated for one AMA ERA Category 1 credit for physicians, one continuing education credit for psychologists, and one continuing education credit for social workers. Credits for participating in today's webinar will be available until August 22nd of 2023. Next slide. Captions for today's presentation are available to download in the webinar chat. Just select the link to view the option. Next slide. Also, captions for today's presentation are available. Click Show Captions at the bottom of your screen to enable, then click the arrow and select the View Transcript to open captions in the side window. Next slide. And please feel free to submit your questions throughout the presentation by typing them in the question area, also found in the lower portion of your control panel. We'll reserve 10 to 15 minutes at the end of the presentation for some Q&A. Next slide. And now I have the pleasure to introduce the faculty for today's webinar, Dr. Marcus Smith and Kelly Winbush Fairley. Dr. Marcus Smith, PhD, LCPCs, years of clinical and advocacy experience have shown a strong passion for working with the underserved population using a trauma-informed lens. From residential, psychiatric, to private practice settings, Dr. Smith has been able to specialize in LGBTQ identity and supportive therapy, grief counseling, spirituality, anxiety disorders, play therapy, life transitions, and mindfulness. Kelly Winbush Fairley is a board-certified behavior analysis, certified managed care professional, and founder and CEO of Key to Hope Behavioral Therapy. Her most prominent work has been with individuals with dual diagnosis of intellectual disability and autism, where she has been a driving force in creating partnerships within the community, bridging the gap of therapy for individuals with diagnosis in black and brown communities. She also created a therapeutic tool named The Black Like Me Mood Chart to assist in normalizing therapy within the black community. Thank you both for leading today's webinar. We're really excited about the content you're going to share, and I yield the floor to you. Good morning. Good afternoon, folks. Thank you, Jose, for that warm welcome. Wherever you're coming from all over the U.S., we wanted to go ahead and first cover some objectives for today's presentation. Three of them that we'll go ahead and cover first is we want to go ahead and first define implicit bias in historical context for black Americans, Secondly, we want to go ahead and explore some ethical codes and decolonizing research that supports unpacking clinician implicit bias. And lastly, we're going to go ahead and cover some tools and also some theories that help a clinician engage in self-awareness and enhance the therapeutic relationship. So first, folks, let's go ahead and look at what the literature says about implicit bias. So what it talks about, hopefully, if everybody can hear me, is that it's about attitudes and stereotypes that affect our understanding, actions, and decisions in an unconscious manner. And so biases comes in threefold. We can have neutral, positive, and negative biases. And our biases refers to our preferences. And so when you think about it, if you think about your own theoretical orientation or favorite food, folks, I have a negative bias towards chitlins, right? Or whoever, no offense to whoever likes chitlins on this presentation, but because of that preference, right, who's to say, I created a little bit of distance, but who's to say that add a little bit more hot sauce and a little bit more vinegar, it actually might taste good, right? But because of that negative bias that I have towards that particular food, right, I don't get to experience, right, the joys of chitlins, right, at family gatherings, right? And so just on a general note, I wanted to go ahead and mention that. But when we think about theoretical orientation, I'm sure you all have heard or seen an example of a theory that you didn't align with your values, perhaps. And you took a few of those examples and may have made some generalizations. But again, who's to say that it couldn't be practiced in a way that aligns with your clients or your values, right? And so this immediate bias that happens for us, sometimes it could be neutral or negative. And so those neutral and negative biases then create some distance and disinterest, right? And that distance then contributes to neglect, right, for me and those chitlins, right? I'm not experiencing, right, that particular food, right? And then that negligence in a clinical, right, environment then can lead to maltreatment, right? So think about that concept of disinterest and distance from our neutral and negative connotations, right, or biases, right? So for example, my neutral bias towards using culturally sensitive theories in my early work with DCFS clients who had symptoms, I emphasize, who had symptoms of severe mental illness, that led to me labeling them as defiant and a poor fit for that particular facility and program and needing medication, right? And so if I had more interest, right, and didn't give as much distance to those culturally sensitive emerging theories, then I would have a different experience with those clients, right? So similar to Black American communities, we have to question, right, similar to my example as well, too, we have to question why a lot of literature discusses how low to potential racism therapy exists, right, and diagnosis of severe mental illness for Black Americans exists. So we're hoping after this presentation that you become more curious of cultural and individual factors, right, that can support Black Americans remain engaged in treatment, explore missing elements in treatment contributing to what appears to be a development of symptoms of severe mental illness. So before I go ahead and check in with a comment in the chat, let's talk a little bit more about the qualities of implicit bias, right? So first and foremost, folks, it's pervasive. It doesn't align with our explicit declared beliefs, and also it favors our personal envy, right? And so first let me speak to the pervasive nature of implicit bias, right? And so, you know, it's likely that in any profession we create assessments of laws that are based on stereotypes or those biases that have a distorted or impartial perception, right, of the lived experience of diverse groups of people. So again, like I mentioned in our example earlier about theoretical orientation or particular food, right, I make decisions, right, based on not including that particular food at a family event. I might be offensive to some of my family members, right, by not including that at that family gathering or with a theoretical orientation, right? I make certain decisions, right, by me deeming these clients in my early work as defiant or not a good fit, right? That was really going to impact, you know, some of the access to services for them in the future, right? And so what was really important to, you know, aside from the pervasiveness of implicit bias is that they're malleable, right? Folks, we have to know that that's a really important part that they are malleable, right? And so a key part of unlearning is really true self-acceptance within us as clinicians, as providers, right, as leaders of the counseling field and psychology that we're all capable of bias and that it's not a threat to our character, right, right, that we're all capable of that, right? And so we have these neutral positive and negative biases there, but it's not a threat to who we are as an individual, right? And so we speak to some of the concepts that unlearning our biases later evoke cultural humility and curiosity that increase the therapeutic relationship with our clients a bit later on. Okay, so I see, okay, all right, that was just comments from the other facilitators. And so now to my colleague, Bentley. Good morning, everyone from Midwest to the West Coast and good afternoon to everyone on the East Coast. I'm very happy to be here and engaging with like-minded individuals in regard to how we can overcome our implicit bias and how we can truly just become a better clinician within our professions. So first I am going to discuss a little bit of the history in regard to some systemic oppression and reasons for cultural mistrust within the Black community. And mind you, these are just a small number of things and reasons for cultural mistrust. So one thing I'm sure that we are all aware of is the mass incarceration of people of color and indigenous people over the past 40 years within the United States. That it was increased by 500% just over the past 40 years. And it was largely due to the war on drugs, which was pretty prevalent in the 1980s. And if we think about just how differently the crack epidemic was from the opioid epidemic today in terms of who had and has the highest rates of addiction and who was criminalized versus treated as a person with an addiction. So simply going to the hospital for someone who was addicted to crack in the 1980s could result in incarceration. I definitely know that there are stories of women who were pregnant and went into the hospital when they were in labor or just for their prenatal care and disclosed to their healthcare professionals that they had a problem and they wanted help and needed help because of their addiction. And instead of being provided with resources or care to help them overcome their addiction, they were turned over to the police and their children were taken away. And nowadays for the opioid epidemic, which much more overwhelmingly affects white people, the hospitals are actually providing care for those who are suffering from an opioid addiction as opposed to those who were living with a crack addiction. Then there is, of course, the ban of ethnic and racial studies programs. And we are seeing this all over our country today in several different states by several different government officials. Government entities and educational institutions have consistently, and more so now than ever, tried and succeeded at omitting curriculum that will inform others of anyone except the white majority. And this has been embedded even into scientific study and within our medical system. So for instance, Black people having a higher tolerance to pain in the medicals field. And I'm sure some of our physicians are aware, even some non-physicians may be aware of the former vaginal birth after cesarean or VBAC calculator and its correction factor, which led to more Black women having an unnecessary C-section. Then we have the infamous Henrietta Lacks or HeLa cells. And I think most of us are aware, if you aren't aware, Henrietta Lacks was a woman who died from cancer at the young age of 31. And her cells were taken from her without her consent and sent to Johns Hopkins for experimentation. And since that time, her cells have been sold and distributed to several labs across the world for experimentation. And reparations were not given to her family until 2020. Then there is simply the lack of research on implicit bias. And that even in us putting together a presentation for you, a lot of our articles were difficult to find because there is just such a lack of research. A lot of the articles that we may find may be dated back 15 A lot of the articles that we may find may be dated back 15 to 20 years ago, because that's just where the information is. And it's very few and far between. Another thing is seeing violent and dehumanizing images in the media from unarmed Black people being harmed or killed within the violent history of slavery, the Jim Crow era, and just oppression of our current times, whether we see it on our daily news or whether we see it in documentaries or social media. It really is all over the place. And one reason for cultural mistrust is that we don't even recognize racial trauma as really being a diagnosis. So can you imagine just going into your health care provider and you're telling them that you're having these issues, you may be, so say you're having trouble breathing, you're having heart palpitations, or something even more serious, and they just dismiss your claims as not even being a thing or not even being real. And within the realm of psychology, the DSM-5 does not include covert traumas resulting from racism and oppression in the diagnostic criteria for PTSD, nor does it have a specific diagnosis of racial trauma. And in fact, racial trauma does not actually meet Criterion A for PTSD. And Criterion A, just for those of you to remind us all, direct exposure to physical and sexual violence up to and including actual death, repeated exposure to traumatic info in a work setting, and indirect exposure by way of receiving news of a traumatic event involving a close friend or a loved one. There's actually a note in the DSM that states that Criterion A-4 does not apply to exposure through electronic media, television, movies, or pictures unless the exposure is work related. So can you imagine, we are completely dismissing the fact that we are seeing reflections of ourselves in the news and on social media dying, and that's not considered to be traumatic or meet the definition of PTSD. So this excludes racial trauma, which is distinctive from PTSD, and that it focuses on the cumulative effect of consistent experiences of racism, and historical and generational experiences of racism. Next slide, please. Okay. So then there is the empirical evidence that shows that racism and discrimination harms the health and well-being of Black communities, and it also increases the risk of our health, including physical health, and simple things like the common cold, hypertension, cancers, and we also, of course, have higher mortality rates. Racism discrimination is a stressor, a huge stressor that includes distress, frustration, and anxiety, and adversely affects our mental and physical health. It can also lead to an increased substance use and risky sexual activity. So our lack of recognition of covert racism, in addition to the lack of empirical measurements needed to definitively define racial trauma, often leaves authentic racial trauma reactions misdiagnosed as depression, substance use, or clinically disregarded altogether. And this includes Black people who have a diagnosis of schizophrenia or other forms of psychosis, whose cultural mistrust may be actually clinically disregarded simply as paranoia. And hopefully this information brings you to ask yourself if your Black client's diagnoses are correct, or if they are living with the effects of racial trauma. Can you honestly say that a client that you may have given the diagnosis of depression is really living with depression, or are they trying to overcome their racial trauma? Next slide, please. Now within the Black community experience with counseling, it does speak a little bit about implicit bias within the literature. And again, the literature is limited that is available on counseling that addresses the racial trauma within the field. And the field has failed to recognize racial trauma as an actual diagnosis, instead of diagnosing Black people with disorders that may have actually resulted in racial trauma. And the literature available states that psychologists who serve the Black community primarily focus on individual level intervention and coping with trauma. So with that, just think about the different theologies or methodologies we use within treatment. We are using ACT, or you could possibly still be utilizing psychodynamic. There are several different theologies that you could be implementing that are only reaching the individual level and not fully recognizing how a person interacts with society and how a person reacts to their interaction with society, i.e. racial trauma. The literature indicates that there are social costs for sharing personal experiences of racism or discrimination, perhaps due to the stigma. So we have to be careful in that those victimized by racism may not care to share their experiences because they have shared them in the past and they have encountered embarrassment, or the stigma, or being perceived as less likable, or even simply as a complainer, or just accused of avoiding their own personal responsibility. This decreases the likelihood that those individuals are able to emotionally process their experiences in therapy due to social punishment or disclosure. Next slide, please. Then there is a little more in the literature that discusses that the Black community must attempt to resolve dissonance between their personal reality of encountering racial stressors and conflicting social messages that indicate racism is not a valid explanation for their experiences, which further contributes to a therapeutic focus on individual processing, which can be dismissive of racial trauma. Then there's a lack of willingness to talk about the traumatic event prevents adaptive social processing of the event. So when your therapist feels that your racial trauma is not relevant, or your physician, or your co-worker, or someone else within your circle does not think that your pain or your experience is real or relevant, it decreases the likelihood that the individual is able to process the event. Then there's a political climate in the U.S. that has particularly contributed to increased stress among Black individuals, and this is according to the actual Stress on America report. Then racism also raises the risk of depression and anxiety and has other devastating effects on the mental health on racialized people. Racism has been conceptualized as a chronic stressor that has the potential to produce trauma and PTSD. It can operate as daily in many traumas that expend psychic energy and result in psychological effects that parallel those of sexual assault and intimate partner violence. So again, I just implore you all as clinicians, as physicians, to truly take a moment to speak with your Black clients and see what they are experiencing, and take the time to really iron out, is this person living with depression due to racial trauma? Do they really have psychosis? Are you dismissing their paranoia as, excuse me, are you dismissing their cultural mistrust as paranoia? Social punishment can look like utilization of an individual level intervention within the therapeutic setting, and that's if the patient even allows you to get to that point because they choose not to share what they've experienced. Next slide, please. Okay, and then let's talk a little about the lack of integration of cultural theories that can negatively impact client engagement. So again, previously we mentioned that the individualistic theologies tend to negatively impact the client engagement because you're actually asking the individual who experienced the racism to take individual accountability for what society has inflicted upon them. So as far as our implications for professional practice, yes, the literature is limited. However, it is still out there, and understanding of racial trauma is especially important for clinicians working with Black populations due to disproportionate and compounding impact of intergenerational trauma, ongoing systemic racism, microaggressions, and cumulative trauma. So awareness is key. It's extremely important that we continue to attend webinars such as this, that we actually look for the research ourselves if we aren't doing it already, that you're making yourself aware of the current climate within the country, and that means familiarizing yourself with current issues and how they've affected your patients. Next slide, please. Furthermore, clinicians have to be intentional about putting forth efforts to recognize racial trauma and promote healing from it. This creates space for clients to engage in storing survival of their experiences, and this allows clinicians to look for opportunities to emphasize historical connections and other contexts that are contributing to specific client circumstances. This will also reduce the likelihood that racial trauma is overlooked and misdiagnosed, and allowing the client the opportunity may help to minimize the tendency to internalize the negative racial experiences, which can lead to those feelings of anger, sadness, and anxiety that are often misinterpreted simply as depression. Lastly, I would like to talk about some of the things that we can do to ask clinicians to actually engage with our clients in non-traditional formats to help them pass their racial trauma. I'm sure most of you have heard of Audre Lorde, who was a great literary artist, I guess you could call her. She has a quote that is very profound, the master's tools will never dismantle the master's house, and it's simply a metaphor for intersectional structures and systems of oppression that created and sustained health iniquity in the U.S. Black communities. So, I'm going to talk a little bit about Audre Lorde, and I'm going to talk a little bit about some of the tools that we can use in our Black communities. So, some of the tools that we could use are radical healing, ethno-political psychology, intersectionality theory, Black psychology, psychology of liberation, and all of those can be used to circumnavigate theories that have traditionally supported bias in counseling. So, what are some tools that are beneficial in overcoming bias and recognizing that we can move beyond traditional spaces and modalities of treatment? So, for instance, you could hold group sessions outdoors and get in nature, maybe if there is an open park, you could hold a session there. Also, something that is very helpful is incorporating spiritual healing practices. Within the Black community, spirituality is key within our culture, and something that we hold on to and utilize as our strength. So, incorporating spiritual healing practices can be helpful in overcoming racial trauma. However, this does require collaboration with spiritual healers outside of Western medicine. So, with that being said, I implore all clinicians to reach out to individuals that are in other forms of healing, other communities of healing, as opposed to staying with inside your four walls of maybe your practice or mentors that you are very comfortable with. Sometimes it takes getting uncomfortable and exploring new practices and new ways of working with individuals to help us overcome what has kept us living with our biases. Great. And so, folks, we know what Kelly has brought to us is some theories that we need to dig for that are non-traditional. And so, we're going to talk more about that in a moment. But first, I want to say thank you for joining us today. And so, we're going to talk more about some of these non-traditional and traditional theories that you can integrate as we continue to move forward. But we also know that research and ethical codes inform our clinical practice. And so, here we have codes in emerging research that encourage us to approach treatment differently with Black Americans. So, we know we need permission to dig for those emerging theories to support Black Americans. And so, we want to be mindful that counseling may have different codes than psychologists and social workers. However, we know there's a common thread of practices in doing no harm, respecting client autonomy, and engaging in justice. And so, when we think about the counseling relationship, evaluation, assessment, and interpretation of those assessments, and supervision, and how we seek further training and education such as this webinar, we really want to encourage audience members to think about what it means concerning therapeutic relationship attunement. And really getting to understand your client. So, what advocacy is needed? What cultural or intersectional factors, as Kelly mentioned earlier, are we incorporating in our treatment planning? So, we're trying to think about, this is just a reference for ACB and counseling code of ethics, some areas that we really want to hold it on. But then we also have decolonization research. So, some concepts that give us permission to go ahead and utilize some of these culturally sensitive theories is that fragmentation is a consequence of white supremacy. Right? And so, it's not just the consideration of the client's identity as just as an American, or their identity in their gender, right? In regards to mental health, right? We really want to encourage folks to be curious about identity integration versus assimilation, right? So, when Kelly talks about this, you know, intersectionality and this racial trauma, we're talking about the white standard, right? That's there, infiltrated in our counseling practice, right? And so, we're processing grief, right? We're processing grief with our clients about navigating systems that don't fit or consider Black American needs, right? So, instead, again, fragmentation, instead of doing the opposite of fragmentation, we're trying to encourage, right, some identity integration, as Kelly mentions, right, on that intersectional lens. Another concept to think about from decolonizing research is how structures position Black people as defective impoundments, right? So, a lot of some of the studies that Kelly had mentioned were talking about how to reframe that there's something wrong with this group innately that needs refinement and change within Black Americans, right? And so, when they come to us, right, are we immediately looking at them from the lens of that bias that there's something wrong with them, or are we trying to see them and be with them, right, as we support them, right? And so, it's not, as Kelly mentioned, it's not Black people that need to be changed, it's the systems. We need to be curious about the systems that we live in, that many of us on this webinar benefit from, right, and how to go ahead and change a bit of that for our clients. Decolonizing research also talks about desire-based framework, working from a desire-based framework versus pain barriers, right? And so, we're not trying to ignore the trauma that's going on for our Black Americans, right, but it positions Black Americans' experiences coming from a place of wisdom, and it doesn't use that pain or emphasize the past in better, a better future. It more so, because that would ignore what is needed right now, right, within that therapeutic relationship, right? So, we don't want to be so far in the past in the future, right? We want to process, also want to be mindful of what our clients are needing right now in the systems that we live in. And lastly, disentering whiteness, academia in therapeutic relationship. So, we're really trying to unlearn traditional ways of knowing, right? As Kelly mentioned about how to unlearn individualistic ways of counseling practice, right? How do we assess the standard of coping skills and what that should look like for our clients, right? I'll talk a little bit about an example of some of those examples of coping skills that our clients have used, and we've worked around that, right? And we acknowledge them in strengths. How do clients disclose their lived experience that we're not thinking from this white-centered lens? And where are our clients in their development, right? And so, based on the cultural values that our clients are coming from, are we not demonizing Black Americans as appealing in their development, or maybe not having certain autonomy, right, at a certain age, or not achieving a certain level of employment, right? And financially being, again, independent at a certain age, right? Are we not demonizing them as a younger point of development, when in actuality, when we reframe that perspective, we can view Black Americans as successfully, right, navigating the systems that they live in that didn't have their best interest, right? And so, as I taught in my human development class, right, we would call that identity reflexivity, right? And there's some other concepts, right, that we can go ahead and share with you all if you guys are interested, right? That notes that an individual successfully actually is navigating the systems that don't have their best interest. So again, we talked about permission, those codes and theories that give us permission to use more culturally sensitive theories and non-traditional practices, right? And so, we want to go ahead and make sure that we cover some tools to help us increase our awareness of how we might be engaging in implicit bias with our Black Americans, right? And so, these are some really beautiful questions that we can ask ourselves. We'll talk about reflective questions and then some additional theories later on. And so, the first one we have here is, what has formed our implicit bias? Where in our own communities have we obtained the knowledge and information and through media, like Kelly had mentioned? Like, where is that coming from, right, that Black Americans need to be championed, right? Do I interact with people that have different lived experiences than me? What privileges do I have that others don't? Do I avoid conversations about social issues, right, with those outside of me, right? And so, outside, the in-group here is referring to the clinicians, the clinicians, right, and people with similar backgrounds. Are we discussing those challenges? A beautiful quote that I love that was added to this book, biased, uncovering the hidden prejudice that shapes what we see, think, and do. They added a quote by James Baldwin, and I love how it says, a journey is called that because you cannot know what you will do, what you find, or what you find will do to you, right? And so, that just further evokes this idea that, again, like we said earlier, that we're all capable of implicit bias. As Kelly mentioned in the historical, right, impacts of implicit bias, like we're, it's saturated and we're really affected, right? It's extremely difficult to not be impacted by negative or neutral bias towards Black Americans as she depicted. And so, it's about what we do with that when we uncover, when we're courageous enough to uncover some of those biases through our supervision and relationships with colleagues and our own work, right? So, again, some tools that we can kind of think of. So, we got some questions, reflective questions, and now some additional tools that we can be thinking about. So, two of them that we want to go ahead and highlight is cultural broaching and dynamic sizing. What the literature talks about with cultural broaching and our relationship with Black Americans is that we can name the possibility of misunderstanding, right, based on different cultural values and backgrounds we may have, right? And then we might want to go ahead and ask our Black Americans, right, how does your cultural background or your value system or your community, right, impact what you're experiencing, right? What is it like with my identities? My being, my would be indicative of you and I, right, in relationship to Black Americans receiving counseling. What is it like with my identities, our identities, to ask what we're asking in that counseling relationship? And so, what that does, folks, is that that gives space for the client to start to conceptualize and think about, like, oh, I can explore how my identity impacts or my identities impacts what I'm experiencing or the symptoms that I'm experiencing. Oh, and by the way, my, my clinician is letting me know that they don't know everything. And I can share with them and tell them and teach them. Right. And that not be an issue. Right. Um, it didn't dynamic sizing is basically making sure that as clinicians, we're considering that stereotypes or certain biases aren't reflective or made as huge generalizations of a particular. Right. So we want to go ahead and make sure that although, yes, we're talking about spirituality, we're talking about some of these considerations that Kelly mentioned, and I'll be mentioning more later on. But we're, we're tuning to the therapeutic relationship. What is this black American experiencing with all their identities, right. As they come to us in that relationship. So we're not making assumptions and generalizing for an entire group. Right. We're still curious about what this person is experiencing. So just as an example of a client. I had a 21 year old black American experiencing homelessness staying with their cousin initially wanting to work on their anger and stress. And so they were experiencing symptomatology, where they were struggling with cognitive flexibility. And then what would be perceived as hypomanic and depressive episodes. Right. And so I'm putting big air quotes because again this is me and Kelly are trying to present today is that these are symptoms. Right. But first we need to be curious about stuff so I'm going to go into the other stuff. And so this cultural broaching and dynamic sizing that I use with this particular client. That was really helpful for us to really expand on the roots of their hyper vigilance. Right. So what were the roots of their hyper vigilance, or the discrimination racial discrimination that they experienced trying to seek employment opportunities. Right. Which is why they were living. And also the impacts of their amygdala right from living in poverty in general. Right. So we didn't use the language amygdala in our relationship. But we certainly talked about the fight or flight system and how living in poverty right that that impacted their daily decision. Right. And so if I had listened to research on black men and assumes they this person fit the bill for bipolar or ADHD or substance use. Right. I would have, I wouldn't have gotten insight to their trauma experiences folks. And so, let's, let's talk a little bit more about theory integration so Kelly was Kelly brought us on some theories that were more emerging right and more updated. And also you'll notice some theories here that talk about that. Right, that you've seen before but that are continually used and updated and clinical practice. And so I integrated the ecological model, cultural theory, multiple minority stress model. And first, the ecological model for this particular client is keep in mind this point that I was thinking about earlier. It really provided validation in client context, what they were experiencing from the macro level to me so to micro systems that they were living. And as we know, and the ecological model is also the problem system. Right. So, it's we're really trying to explore with our clients, what, how are they able to cope with the system that they live in over time. system means over time, how those systems change over time for that client. And so we're really looking at the ecological system we were able to go beyond the four walls of therapy and involve advocacy for services and resources right so some examples where we were able to kind of explore like housing case management employment and social justice efforts on a macro and micro level. I'm cultural theory here, and that's important me to use more cultural humility and curiosity. Right. Like what's the structure of the value systems and customs that you come from my client. Right. Right. What's the client's wisdom that contribute to their own current development, where are these coming from right what are the strengths that you have. Right. Um, and, and lastly, we, I use the multiple minority stress model. And so that addresses kind of like a psychosocial. Right, it explains how stigma right and a lack of equity. A person experiences based on their identities impacts how they can cope with social cycles psychological and biological challenges. So as a result, like I said earlier, I took a strength based approach, and we ran a process client social support. Their social support process distress tolerance and mindfulness skills advocate for better housing and employment and extended free therapy free therapy, so it's sustainable. So that wasn't another stressor that they had to think about versus rush to medication or diagnosis of PTSD or Bible. What was that going to do to my client folks, if I diagnosed them with bipolar or PTSD in this experience when we're thinking about all these different identities and all these different experiences right that they're experiencing from racial. And so my metrics. This is very important. My metrics on how fast. This client was supposed to experience change behavior. Right, such as move regulation, time to their flexibility, it became more realistic right to the client's needs and how they were presented. Right. So therefore I was advocating for longer treatment and exploring resources with them. And I was meeting them where they were at. Right. Do I look at my client people lens of engaging in high risk behavior know my client, very much disclose that yes, I had to either go ahead and deal. Right, or I had high some high stress yes Marcus I just know yes, the mindfulness work sometimes but sometimes I need to smoke a little weed. Right. And so that that was important for me to say okay yeah yes yes, this is where you are. If I was to go ahead and demonize that and say that they are engaging in risky behavior. I would have been at a loss for this part. So no, I don't, I don't look at it from this thing. So, I see it in the context of those multiple minority stressors and meet them where they're at. And so the prognosis for this fine. They grew in tolerance of finding more of the middle ground and relying on resources and social support to get to their basic needs met. Right. So what I mean by middle ground folks and I see we're going to go ahead and wrap up our quick q amp a is living in poverty, they were thinking from the mindset of. There is no middle ground initially when I first met them. It's either life or death. Right. Right. It's either survival. Right. And so over time, as I began to use these theories with them, it provided context and validation, and they no longer internalize their experiences so that gave them the space to again start to realize that some of these metrics to achieve certain things they could take a little bit longer. Right, so they felt held in their relationship with myself. So I wanted to make it and just pause there and that's kind of how we use some theory integration additional theory integration. There are more resources to watch, listen and read. And I see Jose keeping us on our toes. Thank you. Right. Let's go ahead and walk into some q amp a. Yeah. Can you move on to the next slide please. So, first of all, thank you so much. This was a very important topic and extremely timely. I really enjoy the fact that you highlighted the way we have to look at the system setting the foundation to make sure we reassess our lenses include the community aspects of spirituality, saying trauma is the foundation for the work that we do, which is fantastic. But before we move into some q amp a I want to take a quick moment and let everyone know that semi advisor is available via the mobile app. You can use the SMI advisor mobile app to access resources, education, upcoming events, complete mental health grading skills and even submit questions directly to our team of SMI experts is as easy as downloading the app. So the app is SMI advisor.org or slash app. Once again, SMI advisor.org or slash app. Next slide please. So, let's really talk about some, some next one. Next slide please. So now we're going to get into addressing some of the questions we have from the audience. So, the first question that we're going to feel is, how do we start having these conversations that are related to trauma in a sensitive way with the people we provide be traumatizing or without pushing that specific person faster than they can go. I can. One thing that I would say is, as far as not pushing them faster than they can go is, that's more so where you have to let them lead the session. take moments to sit in silence, as uncomfortable as that is. It just allows space for the individual to know that that space is for is for them to speak their truth and speak when they need to speak, they may need to sit in that silence for a second. I would also encourage that particular individual to find other like minded individuals, and perhaps recommend an actual group. Perhaps a support group for individuals who may have experienced that same particular trauma. Yeah. I would add to that and say that. So in trauma, trauma informed care we talk about pendulation. Right. And so what that means is that we try to pendulate and attune to like what Kelly is saying, use some sounds and go at the pace of where our clients are at. And so, a pendulation will indicate that we will talk about some sensitive challenges, and then pendulate to maybe some more lighter experiences and so the feeling that I got from there is like not to rush and that's why we are advocating for, you know, extending treatment right and being patient right with our black American clients right when we think about the history that Kelly was bringing up is that we as black Americans we haven't had the space to be able to work through our trauma just name our trauma in the first place so that's going to take some time folks. Right, that's going to take some time this is not something that's to just be fixed immediately quickly and tight and packaged up. Right. Because I'll say other groups of privilege have been a lot of years and centuries to work through their trauma or come have access to therapy. And so when you think about that systemic kind of cultural value. You want to give that time. So, that's it. So that's a perfect segue for my next question is that how do we educate the people we serve to recognize when they're experiencing. The ability to be able to provide. So it's about awareness like supporting client awareness. Okay. Okay. Well, so first and foremost, right so we saw how we talked about in decolonizing like research we don't want to go ahead and emphasize pain narratives. So, the first thing that that comes to me, and using a decolonizing lens is using the client's language. Right, so we don't want to just come out off the bait, you know just saying like you experienced trauma or you experienced, you know, a lack of consent or you experienced this right you, you want to go ahead and use a strength based approaches we talked about in our presentation, and of course use the client's language in that process. Right. And again, just show some tenderness again that pendulation takes some time to go ahead and identify right how they how they choose to go ahead and work through some of their trauma use some of that wisdom. And when they realize that either some of what their techniques or what they've learned through their own community and their own understanding isn't enough. And that's when maybe we can go ahead and add Okay, well, I know this thing called mindfulness is this do you want to try that out. Right. I know something. Right. So, I'll say that I didn't know if Kelly, we wanted to answer that. The only thing I wanted to add is I really liked what you said Dr. Smith about speaking the client's language. One reason why I created the black like me moon chart what for therapy was so that our black clients could use African American vernacular English to identify in session, how they are feeling. So actually using the language with in which they are comfortable and communicating with their families or their friends that may not be the most, what is considered the most professional and white American culture, white standard right right so we're centeredness right. Right. So it also reduces the, the power dynamic within the therapy room to where it takes away that that level of power to where you're communicating on that same level and then it helps the individual actually identify. Hey, this made me feel this type of way I didn't quite know how to describe it but it made me feel like this and I know if this situation normally feels like this and that's not okay. So that is a way is a stepping stone to identifying and pinpointing, some of the trauma, they've experienced, making sure they're being seen, or they're being heard. And also have those practical applications of care, Dr. Smith, I found that refreshing that you highlighted that you were providing care in one aspect and the individual mentioned that they smoke a little bit here. But also will find harm reduction practices to our care, which is part of the story of part of who they are and we're accepting everything and, and to finish it off with something that you mentioned Kelly is the fact that we're having real conversations with real people. And this is not about a diagnosis is about trauma informed care services and being very sensitive to the experience, the historic experience that a lot of our communities have had. So, we have, we have about time for one more question and there's, I'm going to pair them up there's two of them they're asked the audience is asking if there's any programs or curriculums that you can use to train, and someone's asking about if you recommend heat when working within the black community. Because I believe is an acronym. Okay. Are there other trainings that are involved, right and so, you know, Kelly and I are definitely connected to individuals that do a lot of di trainings and we do we do them ourselves as well too so you know unfortunately kind of like how we were talking about in our literature review. You kind of have to go explore based on relationships but we definitely do have, you know, right, connections where individuals could be connected to individuals that do more of this self reflective reflective practice. In addition to us also doing webinars, where we challenge folks to consider some of these concepts and clinical practice. I would say, again agreeing with Dr. Smith. You are working with a small budget as most social service agencies are, I would definitely recommend a couple of different readings. One is an essay by Peggy McIntosh. It's called unpacking the invisible knapsack. And that is a very very helpful. Essay because it's it's written by a white woman and she is pointing out white privilege as it is. Then there is the book white fragility by Robin DiAngelo. And what is great about these particular books is that they do help white people point out their, their white privilege, and it's pointed out by another white person. So just like anyone, we need to find a community or group or sometimes you may hear something in a different way. If someone, if you have something in common with that person. So I do find those particular pieces of literature helpful when, when doing trainings. I wanted to add to that what you said, Kelly, do we have enough time for that or I know you guys are trying to keep specific to time. So maybe we can share the resources with whoever's in the audience and everybody can share. Okay. All right, so can you move on to the next slide please. If there's any topic covered in this webinar that you would like to discuss with colleagues within the mental health field, please post the question or comment in the SMI advisor webinar roundtable topic discussion board. This is just an easy way for you to network and share ideas with other participants who are part of this webinar. If you have any questions about this webinar or any other topics related to evidence-based care for SMI, you can get an answer within one business day from one of our national SMI advisor experts. This service is available for any clinician, peer support specialist, administrators, or anyone else within the mental health field who works with individuals with SMI. This service is completely free and confidential. Next slide. SMI advisor also offers more evidence-based care guides on cultural competence mental health care, such as the fact sheet, cultural competence care for black American adults living with serious mental illness. This guide addresses common barriers to access to mental health services and provides practical strategies to overcome them. You can access the sheet by clicking the link in the chat or by downloading the slides. Next slide. To claim credit for participating in today's webinar, you have to have met the attendance threshold for your profession. After the webinar ends, click next to complete the evaluation. The system then verifies your attendance for credit claim. This may take up to an hour and is based on your local, regional, or national web traffic and the usage of the Zoom platform. Next slide. And last but not least, please join us next week on June 29th as Jessie Clever and Helen Skipper present meaningful community participation for people with mental illness, a model and movement. Again, this free webinar will be Thursday, June 29th at 4 p.m. Eastern Standard Time. So that is all for us today. Thank you all for joining, and I'll see you next time. Take care, everyone. Next slide.

racism

Black mental health

implicit bias

counseling

systemic oppression

cultural mistrust

cultural sensitivity

trauma-informed care

racial trauma

implicit biases