Hi, everyone, and welcome. Thank you again for joining the Third National Conference on Advancing Early Psychosis Care in the United States, presented by the SMI Advisor. My name is Iruma Bello. I'm the co-director of OnTrack New York, a coordinated specialty care program, and I'm very pleased to moderate today's session entitled Towards an Inclusive Practice, Creating Safe Spaces in Supervision and Interprofessional Teams to Address Inequities and Optimize the Delivery of Behavioral Health Care Services. This session has been designated for one AMA PRA Category 1 credit for physicians, one CE credit for psychologists, and one CE credit for social workers. Now I'd like to introduce you to the faculty for today's sessions, Dr. Hela Torning, Mr. Luis Lopez, and Ms. Pascal G. Noel. So Dr. Hela Torning has a PhD and is a clinical professor of psychiatric social work in psychiatry at Columbia University Vigelis College of Physicians and Surgeons. She serves on the leadership team of the Center for Practice Innovations in the Division of Behavioral Health Services and Policy Research at New York State Psychiatric Institute, Columbia University. She is also the director of the ACT Institute. Dr. Torning has expertise in addressing practice change through workforce development, transformative learning processes, and quality improvement. She is a licensed clinical social worker training clinicians and working with people facing mental health challenges and their families. Luis Lopez has an MA and an MS, is a counselor, trainer, consultant, and coach. Mr. Lopez is the coordinator for fidelity and best practices at the ACT Institute and has been at the New York State Psychiatric Institute since 2013. Mr. Lopez has expertise in the areas of trauma-informed care, motivational interviewing, dual recovery, group dynamics, cultural humility, stages of change, harm reduction, RAP, cognitive behavioral therapy, wellness self-management, and the ACT model. He has facilitated workshops in these topics at more than 100 conferences nationally and in Canada. Pascal G. Noel has a BSW, MSW, LMSW, and she is the director of training for the ACT Institute at the Center for Practice Innovations at the New York State Psychiatric Institute in Columbia University. In this role, she designs, coordinates, and facilitates extensive training curricula in the ACT model, person-centered treatment planning, and cultural humility and awareness. In collaboration with New York State Office of Mental Health, she oversees training of 108 ACT teams and 1,000 ACT providers. Ms. Jean Noel currently serves as a member of the statewide multicultural advisory committee advising the New York State Commissioner of Mental Health. The speakers report no relationships with commercial interests or conflicts of interest. Now I will turn the presentation over to our presenters. Thank you. Thank you very much for that wonderful presentation, and thank you for everyone who's able to attend this phenomenal conference and to make time to attend our workshop. We are very happy to have such an audience and to share some of these ideas and practices that we ourselves are trying to continue to formulate and to implement, not only where we work, but also in areas that we are connected to throughout the city of New York and the state of New York. But let's talk a little bit about the learning objectives for today as we begin to assess our path with you for the next couple of minutes, right? Identify current social justice issues impacting our work today. This as you know, is a very, very important area of work, not only in socioeconomic and sociopolitical arenas, but also clinical arenas, because this affects not only participants that attend our programs and receive services from us, but also many, many, many staff members that are part of our workforce and part of the behavioral health framework, right? So it's important to be able to have an opportunity to share and talk about these issues. Include challenges and opportunities for teams and in supervision when addressing white supremacy and white privilege. And again, we're going to be redefining those terms as we present throughout the conference today. And we want to make sure that as we speak about these terms, we are on the same page. And describe how critical conversations, our model provides a framework to illuminate and examine power dynamics in order to produce change with parallel insight and action across teams, supervisees, supervisors, towards an anti-racist practice. So we also want to provide a model, a technique, an approach, a methodology that you could incorporate in the conversations that you're having with staff members, with colleagues, with other administrators, as you have these conversations in your own programs and agencies. The course outline for kind of going along with us as we present today, right? We are going to be covering current social justice issues impacting our work, right? Areas of power and positionality in COVID-19, interprofessional teamwork, establishing a vision, right? Creating safe spaces, right? What we call keeping it real, right? And when we keep it real, we talk about our positions in our work. And having those critical conversations that sometimes as Pascal is going to talk about are sometimes uncomfortable, but they have to happen, right? These uncomfortable conversations are the exact conversations that we learn from and help us reflect on where we are when it comes to these very, very important, yet critical and complicated conversations. Transforming our programs and agencies, right? That's kind of like the whole point of the presentation. Having a model that you could take back and run with it, right? Not only you have it back, but you could run with it. You could try it. You could start conversations on a very small scale and slowly build from there, you know? And at the end, having some more dialogue and conclusion. We invite, you know, we, as we do presentations, we enjoy the conversation. We encourage the conversation. We want people to be engaged and to be critical of what we talk about. So we do not mind if in the chat box, you throw some comments, you put some observations, you, you know, share some key thoughts, you know? Please do. Do not hesitate. And we'll try to catch a few of those and incorporate them in the conversation, okay? Next. We are part of the ACT Institute. All three of us have been working with ACT teams for many, many years, and the ACT Institute is a unit at the Center for Practice Innovations, which is located at the New York State Psychiatric Institute, which is located in the great city of New York City. And we are located in Washington Heights. We are part of that very famous campus of Columbia Presbyterian. Everybody knows Columbia Presbyterian, right? Very well-known hospital. We're part of that hospital up in 168 in Washington Heights. As the ACT Institute, we work with 108, with 108 teams. New York State has 108 teams. So it's a state that's very lucky to have that ability to work with so many teams. The ACT Institute was established in 2003, okay, when New York City and New York State became Medicaid billable programs, right? When Medicaid became the way that ACT teams moved through the system, that's when the ACT Institute was developed to support those teams that were coming around that time. We believe in regular training on the areas of evidence-based practices. If you're familiar with ACT teams, the teams are pretty much a nucleus of best practices and evidence-based practices as each clinician participates in one of those areas plus participate in the overall running of the team. Ongoing training and implementation is extremely important for the teams because we want the teams to be up-to-date not only with clinical practices, but also with policy, legal issues. COVID-19 is a good example. All the different changes that have been happening since COVID-19, particularly in the area of telehealth, telecommunication, and telephonic services. We in the ACT Institute continue to keep teams up-to-date with these issues. And of course, being a training institute, a teaching institute, we move through educated blending systems where we're able to work from face-to-face trainings to virtual trainings. As you can imagine, most of the trainings in the past six months have been virtual and they will remain virtual until there's a better handle on how to work with COVID-19 to be able to, once again, take all these training opportunities to different areas of the state. Otherwise, we will be traveling to areas like Buffalo, Syracuse, Binghamton, and work with teams in those areas providing face-to-face sessions. Next. So here, we are going to begin to review areas of our presentation, and we're going to start getting specific. So I would like to ask Pasquale to take the platform. Thank you, Pasquale. Okay. Good evening, everyone. Good evening. It seems like it went by so quick up until the slide. That was fast. Okay. So if we can go to the next slide, please. All right. Louis, feel free to jump in on this one with myself, with me as well. This slide here talks about the social determinants, right, of mental health, social determinants of the folks that we work with, i.e., and particularly is often related to our black and brown population of folks that we work with. But this is also, I want to add a also real description of structural racism and what that looks like in the communities of the folks that we serve within the communities and the systems that we work in. So when we're looking at trauma, adverse early childhood life experiences, right, housing instability, how that definitely impacts, you know, someone's mental health or even the ability to receive mental health and services. Social exclusion and social isolation. Now this one in particular, we have it noted, right, again, these are social determinants more than likely for black and brown communities. I also identified also aka always known as poor communities. But unfortunately, you know, whether someone comes from a poor community or not just being identified as a BIPOC, a black indigenous people of color, right, you're automatically put into this category. Now let's even take away that with COVID, everybody was automatically put into the category of social exclusion and social isolation, sorry, isolation. So it's time that we start really looking at the structures and the things that we have always been taught to describe the systems that we're working in, intentionally calling things out for what they are, poor neighborhoods and built environments, knowing that these are things that are by design, that really impact people of color, poverty and low income and income inequality. Now we could even look at this a little bit deeper. Yes, these are societal structuralisms within communities, but these are also within our institutions and our environments. Income inequality, who's getting paid more versus who's getting paid less within the very institutions that we work in. And oftentimes with the same credentials, who's given opportunity for advancement versus who's not given opportunity for advancement. And oftentimes it is BIPOC people of color, black and brown indigenous people that are the lowest on the totem pole despite all of the credentials and all of the monies that they may have compared to their white counterparts. Low income and education inequality, access to education, access to equal education, who gets into programs versus who doesn't, school systems in certain communities. What does the curriculum look like? Often in black and brown communities is a prison to pipeline. So it's set up from childhood that children that come from black and brown communities are often ending up in the system and the system has started to create failure for them from the onset. It was designed. So obviously these things are going to continue to impact someone's mental health or put someone at risk of mental illness, poor access and quality to access, sorry, poor access to quality of healthcare. Now, even if someone, okay, comes from a poor community, right, yes, these things are outlined to happen where you're not going to have the appropriate access, you're not even when we're talking about vaccines, you know, even when we're talking about access to COVID testing, which communities had earlier access versus which communities didn't, right? Even if, for example, a black woman like myself, having access to healthcare, having good insurance, still being treated less than because of my black skin when seeking medical care, just because of the structural racism that continues to plague every system that we belong to and work in, food insecurity. Now, yes, these are designed and built in certain neighborhoods, but look at how we're all going to be experiencing it or have experienced it with COVID. Now, it's time that we stop, stop minimizing the structural components of the things that are happening or that continue to happen and plague the communities, black and brown communities as it is specifically, especially, right? Unemployment versus underemployment, again, these are what we call social determinants, but it's structural racism in the flesh, it's just broken down to help us to better understand why certain communities have certain outcomes. If we could go to the next slide, Louis, and Hela, I don't know if you want to add to this in any way. Louis. Well, absolutely, yeah. Next slide, please. I think you bring a very crucial, I'm getting a little bit of echo. Okay, great. I think you bring a very crucial point, right? Because you got to think, and one of the things we propose to do is kind of make sure that definitions that we're using are clear for the audience, right? We're using certain terminologies that are part of social justice language, and we want to make sure that these terminologies are clear so everybody's on the same page, right? So think of all these different social determinants. They have avenues, right? They're particular ways that these areas are implemented in neighborhoods, right? And the way these things are implemented are called gatekeeping. Are people familiar with the term gatekeeping? If you are, just put it on the chat box that you are familiar with what gatekeeping means. Because what gatekeeping means is that there are people in a number of administrative seats, a number of political seats, a number of healthcare seats, a number of seats with power that make the decision on how resources get to neighborhoods, okay? Think about that for a second. It's a person or people that make decisions on how resources get to neighborhoods, okay? That is called gatekeeping, all right? So if everyone in the room do not reflect the people that those services are supposed to get to, there's always high probability that a lot of it will not get to that community, right? One of the things that we talk about when we talk about white supremacy, we're not talking about this extreme idea that, oh, white supremacy means that people from the KKK are running these gatekeepers. No, we're not saying that. What we're saying is that white supremacy comes in when people of color are not in the room, are taking in the conversation. People of color should be in the room. They should be included in the conversations. They should be part of who makes the decision of where these resources go to. If the people controlling the gatekeeping gates are not representing those communities, then those communities typically get less resources. And this is where the struggle begins, right? Less money for education, less money for healthcare, less money for proper housing, less money for clean streets, less money for maintaining lights and areas safe, less money for food, right? And I could continue and continue and continue to draw different problems. So now you got a community that is completely being oppressed by the lack of resources, the lack of inclusion, the lack of representation, right? So this is an issue that we need to discuss, right? Who are the gatekeepers that maintain power and where resources go to? And are those gatekeepers being fully represented by the people that are in those communities? That's what gatekeeping is all about. Pascal, back to you. All right, thank you. Next slide, please. And Luis, that last slide really illustrated, right, the gatekeeping piece. And the language, the intentional language that we need to really hone in on, the police violence, right, the community violence, policy violence, and how that all impacts racism and discrimination and really complements the structural racism that goes on. And then all the other areas, the courtroom, health care, workplaces, we don't talk about workplaces. Luis, you said, you know, having representation of people of color when making decisions. When we look at the evidence-based practices or the theories and everything that our systems go by, an honor is always from white men, right? It's from white men and or white women. Not enough. But at the same time, bottom line is there's no representation often or allowance for people of color to even have an opportunity to participate. And if so, the person has to be able to endorse the white narrative in order to stay a participant. So there comes the survival mode. So yes, if we could go to the next slide, sorry. So this is a study, a visual of the ACE study, right, Adverse Childhood Effects of Trauma. Now, we don't talk about this enough, but trauma is the root of a lot of our, a lot of disorders, right? Trauma is the core. Experiences are trauma. Being oppressed is traumatizing. Coming from generational stuff, it brings on trauma. Louis, you have a very good way of actually talking about the areas highlighted here on this visual. The generational and historical, I love it, is the root, right? We don't talk about that enough. We don't look at that enough. What historical and generational, i.e., structural racism within our environments, within our DNA of America. Yes, I said it. The core is historical, historical oppression, right? And then it starts to impact us socially and locally. I mean, common sense. If there's something within my root and my core that's just not healed and not doing well, and it's a violent cycle, I'm going to start to adapt ways that are unhealthy in order to survive. But for me, it is some form of survival in healthy way, right? Then eventually, as a child, I get that experience, or I finally get that eye opener from either my environment, from either my school. Sometimes I'm getting it and I'm not even understanding what it is, but I just know that I just have to follow the rules or else, right? It has impacted me, and now it's disrupted my neurodevelopmental cycle. Like, now it's really, literally a mind boggle. And I would use a French term, but I'm going to stay clean here. It is a mind... So you can kind of figure out what that extra word was that I'd add to it. And it starts to mess with your brain. It starts to mess with your mind and eventually impact social and emotional components of your life. So your cognitive thinking, like you're really having to finesse a way to manage life within this corruptness, within this cycle that is so vicious. And then eventually, you start to adapt some health risk behaviors, which turns into a disease and a disability, which impacts your social environment, i.e. a disorder, right? And then eventually death. Now, this looks like something that happens fast, but this is generational and over time. That is a real, real serious experience. Louis, feel free to jump in and add on this one. And you know, Pascal, the interesting thing as you're speaking, right? Typically when people do the ACE study trainings, right? A lot of people have done the ACE study training. They're very comfortable with the theory of adverse childhood experiences. However, most of the trainers do not include social conditions and do not include generational historical trauma. This is not something discussed in many ACE studies training agendas. So to have the ACE study pyramid, which is so famous and so many people are familiar with it, but to also add the social justice component to the ACE study makes it more real. Because a lot of times people wonder where do all these traumatic events originate from? Well, they originate from families a lot of times that historically have been oppressed by systems that have never worked with them, you know? And you just have so much, it's like you stated, so much sadness or anger or just isolation, not belonging to anything, right? And these are the things that continue to add up to unfortunately, you know, being illustrated by traumatic events when people are very young. So this pyramid is just such a powerful pyramid, Pascal. And I used to often say to you, Louis, like this pyramid is missing racism. Like it needs the word racism. And oftentimes like a lot of these things are not included in these studies because the people that are in charge of the studies don't have to experience this stuff. So they don't have to think about it. It's functioning from an area of privilege, right? Where is the inclusion of what really is impacting people and causing all of this intergenerational stuff that continues to become a cycle, a vicious cycle of life? All right. So if we could have the next slide, please. Okay. So let's start to key into some actual questions. What is inequality? What is inequity, sorry, and inequality? Ha, food for thought. What is, oh, thank you. I see the link for the ACE study, including racism. Thank you, Anna, thank you. Yes, we need to start adding these things and bringing it into the room. All right, so next slide, please. These are some visuals that we're gonna show you. So what do we mean when we say inequity and inequality? So if you can please, in the chat box, say something to us. What do we mean by, when you hear the word inequity and inequality, what comes to mind for you? What do you mean, what do you, what do we mean when we say structural inequality and inequity? And how does this impact BIPOC's health and behavioral health? Inaccessibility, yes. Okay, barriers, absolutely, barriers. And equity and inequality. And guys, we want you to really think about that. Imbalance, right? We give an illusion quite often that everybody's equal, and it's not, it's not with the same equity. Okay, built-in inequalities and obstacles. Yes, yes, yes, yes. Who gets access versus who doesn't get access? Opportunities for access, right? Who has it harder than the others? Privilege is another one. And just keep thinking about it and keep typing in the chat box some of your thoughts. But if we can move on to the next, impeded access, I love that. Discrepancy and ability and opportunity. And here is an actual visual of white supremacy, structural racism, and at its finest, and what that looks like. Hella, please jump in on this one. Thank you, Pascale and Louis, and thanks for everybody with your, all your things that you're putting in the chat box. So we thought that we wanted to just pause a bit, just, you know, right here and thinking about when we talk about these systems that are being held in place, and when we talk about white supremacy. So this pyramid, the iceberg of white supremacy, is actually a really good way to look at what we mean. So obviously, when we say white supremacy and we see the top of this iceberg, we see that these are all the things that we really find unacceptable, right? And I think we could all agree that lynching and hate crimes and blackface and using the N-word, that's all what we would say is unacceptable in terms of white supremacy, and often kind of is what we think about when we hear the word white pride. But then when we look underneath the line, the black line here, and look at covert white supremacy, that's many of the things that's so embedded in the way our society works and what is more socially acceptable, in a way. I'm doing a little bit in what people see, what people, what we witness, and some things what we don't really pay attention to. So you can see there are many kind of words in this at the lower line here that is, you know, many times it's not really, people are not aware of, it's kind of unconscious because it's so embedded in the way our society works and the way that Lewis and Pascal really demonstrate and talked about sort of the, why we have these differences and in how people receive or are in, you know, basically who dies in our society and who lives. It's that dramatic. So this is a good way to really differentiate between when we say white supremacy, the word, and it took me quite some time when people said, you know, talked about white supremacy as a white woman, you know, I did not want to identify with white pride, for example, and hate groups. So I kind of, you know, didn't want to take on or take responsibility for being part of that. And when I look underneath the black line, those are all the things that I, as a white woman in this country really have to consider and think about as also part of white supremacy. So thank you, when I see a lot of people have responded to this and I'm liking the visual, but it's a good one to kind of look at and think about with one's colleagues and friends and families. So anyway, should we go on to the next slide, please? And also too, back at that slide too, Hella, if we could go back real quick, I just want to make this statement and have folks really look at it. When we're looking at the definitions or the wording here around covert white supremacy and overt, I want to say that it's not just white people that have this belief. You can be BIPOC and still have white supremacy ingrained within you. The structures were built for you to have white supremacy ingrained within you. You have to also be mindful that it lies within BIPOC as well. And that's the real intentional work really happens and needs to happen. So, okay, if we can move on to the next. All right, so here's another visual. Here's like a real visual of inequity versus inequality. Sir, on the left-hand side, doesn't have anything in front of him except for those little hurdles, that's what they call them. And they are set aside in a way that if he doesn't have to jump over them to get to the end, he can go around them. Where is my sister girl on the left-hand side, sorry, on the right-hand side, has a bowling chain, has all kinds of things, even that little alligator, right? And what do they call that wire with the sticks? That's the barbed wire, they call that. And all kinds, you got the brick wall and there's no room to walk around even if she wanted to, okay? So oftentimes when you hear, well, we both have the same opportunities, I just worked a little bit harder in order for me to get here, you just have to work a little bit or pull yourself up by your bootstraps, guess what? Even if you do that, there's still obstacles that are put in place on purpose for people of color. On purpose without even realizing it, the white supremacy structure, right? Structural racism has that embedded in it without it even realizing it, right? So no, I don't have equal opportunity as my white counterparts, let's be real. I don't have, whether it's my white female counterparts or it's my white male counterparts and even POC, right? Depending on what, who, again, it's still, there's still anti-black racism within despite all of the differences, anti-black racism is so clear. So once again, people of color, BIPOC, do not have the same access to equality as their white counterparts. And I think this visual just demonstrate, we can joke and say, oh, this looks like a game of thrones. It looks like X, Y, and Z, it's a show for some of you. It's a lifestyle for the rest of us. It's no joke, it's real. Next, please. Okay, so structural inequity and inequality refers to the total totality of ways in which societies force the racial discrimination through mutually reinforcing systems of housing. So this basically is summarizing what we just talked about. Systems of housing, right? Education, employment, earnings, benefits, credit, media, healthcare, criminal justice. I'm sure there's a couple more that could be added into that. These patterns and practices in turn reinforce discriminatory beliefs, values, and distribution of resources. Bang, guys, it's a nice eloquent description, but it's so hard for people to even just understand and really conceptualize and perform accordingly once you hear this. It takes a lot of self-determination and really cultivating an environment around you that can help you to work on that as much as possible. All right, next. Okay, Hella. Yeah, thanks. So these are some of the behaviors too that we begin to see or we see, observe, in terms of characteristics of systemic inequality and inequity. And often among white people, we know that we have power hoarding. We maybe fear open conflict, individualism. And we find it, you know, this idea of right to comfort, you know, that we often feel like if we are feeling the discomfort of some of the things that Pascal and Lewis were talking about before, we feel like we have to kind of comfort one another because it is so, you know, we talk about the white fragility. We also think about perfectionism. Everything has to be just so and in control. And a lot, again, when we talk about white supremacy, these are the things, these are the kinds of behaviors that we often see that will hold things in place and not threaten this status quo. Lewis and Pascal, if you want to add something to it or if anybody else in the chat want to add some of these terrestrial risks of structural racism that we see. So, Anna is also talking about this slide is not captured by our criminal justice system. Yeah. So, go ahead. I would say that, you know, when we think about, when we think about these areas, right, this actually is about white supremacy culture, these bullet points. Again, white supremacy culture is the heart of everything within our foundation of America, right? So, it really bullets out a lot of our behaviors that we have to incorporate within ourselves in order to survive within our environments. So, it's something that should always be re-evaluated and interrupted as much as possible to welcome indifferences of others. Lewis? Yeah, I think the one that has come up a lot now is the inability for people to be able to identify that there's something wrong, you know? I mean, I have even heard terms like snowflake. You know, if you are saying something that is offending you or you feel that it's not the right thing, now you are labeled a snowflake. You know, get over it, grow up. Man up, man up, you gotta man up, right? Or people are so sensitive. Well, the sensitivity is because the commenting and the joking around and the sarcasm is out of hand. It's just cool a lot of times, the comments and the lack of sensitivity when people are sharing these type of behaviors. You know, we are in a point in our history where this has become okay. This has become okay for me to share the fact that racism doesn't exist. You know, one of the questions on the chat box, which is a great question, is what do you do when people that doesn't believe, they don't believe in racism? You know, it takes a lot of education and a lot of patience. A lot of patience, you know? And the reality is that you're not gonna change everybody, but I think it's important to stand up for truth. And like we said on the agenda, you gotta keep it real. You know, you gotta keep it real. And people are talking about the slides before I pass it back to you, Hela. We don't have any issues sharing the slides with people. So we'll talk about that at the end of the presentation. Next slide, please. So we wanna keep going on thinking about this or how this shows up in our work setting and also what really the more you get run sort of drill down to what happens with all of this in our, in where we work and also how we interact with one another and also how we think about the people that we serve. So next slide, please. And how does, yeah, how does this impact on behavioral health and challenges in behavioral health? Next slide. The barriers that we have talked about are really the long history of inequality and inequity or by part by mental health system that creates this mistrust and that treatment decisions are often made without the voice of service participants and their family and natural supports. And culture and race, as we've talked about, is not considered in the fullest as the way it should and as the way we need to move forward. Next slide, please. So let's get to talk a little bit about our interprofessional teams and how we can take these concepts or these ideas, what we are talking about now into the work of our teams. And I really welcome you all to think about it as we are going through the next set of slides. Next slide, please. So just quickly, interprofessional teams, right, is, it's a team that's made up of behavioral health or health professionals, peer staff, peer specialists, service participants and natural support to family members. And so when we talk about interprofessional teams, we really think about everybody in a very collaborative working together. And that can either be coordinated, co-located or integrated. So an ACT team is an integrated team, but many people work across, you know, across location and try to coordinate, you know, people from different disciplines or different professions. And what we are advocating is that you really, we need to include peer specialists and the families or the natural supports of that person in our interprofessional teams. Next slide, please. So why is it so important that we work together on this and we think about these many issues and very complex issues as we talked about before? We need to really bring together what it's all these social factors, how they drive the poor health and behavioral health outcomes. Why is it that these things lead people is like we saw in the ACEs study to have much more devastating and traumatic effects on people or by poor people. And that's why we need to work together as teams and professionals from different scopes of practice to really be able to put together all our thoughts, all our heads to address very complex behavior and healthcare issues. And that why social really thinking about that and as we talked about before, that's really steeped in a long history of structural racism and that's really the root cause. So social determinants of health includes economic and social conditions that influence individual and group differences. So we need to think about how we together and that's really why the team collaboration comes in that these are complex issues. They are very steeped in white supremacy and structural racism. And so that's how we need to be working together to really address these issues. Next slide please. Again, the interprofessional team is the cornerstone, right? So effective teamwork is gonna make this interprofessional team work and collaborate with one another. We really need to think about how we as a team comes together. And that can be challenging, particularly if you're coming from very diverse backgrounds, if you're coming from different races, if we are, we also have within us, these, the structural racism, the white supremacy, the, all of these things, we don't, they are, because we are behavioral health providers, we don't escape that these are things that are also within all of us, and that when we come together, addressing these issues together is really important if we are going to serve and improve the way that we are working with the people that we serve. Next slide, please. So how do we bring a team together? And that's really what we wanted to really hone in on and focus on with you. So how do we do that? How do we bring a team together? We develop a shared vision and mission of our work. We know, we have to know the team, we have to understand each other's roles, and more importantly, we have to know the people behind the team roles. And knowing each other, really, and understanding where we are coming from, each of our narratives, understanding the challenges and opportunities and the differences for your white colleagues to your BIPOC colleagues is really important as we try to understand how we then interact and are together and work together as a team. Next. We also need to think about how we use a collaborative leadership so that you, while you're talking about these very complicated and complex issues that can be very uncomfortable from time to time, you also have to kind of keep yourselves on track so that you're also accomplishing the work that you need to do. Next. And to have a framework or structure so that you can have a team dialogue and you can, sorry, and that you can understand the team, that you can really bring in the dialogue and towards a collaboration. Next slide, please. And that's really what we talk about, these interprofessional communications skills, having safe, having brave conversations where you can address one another on the issues that come up when somebody might be acting or behaving in a way that might be unconscious, but still might be racist, or looking at people, BIPOC people, in a way that doesn't take into the history and all the different things that we learned about or talked about before in terms of intergenerational trauma. Next one, please. And then, again, thinking about your team from a trauma-informed perspective and looking at how stress, racial stress and trauma impact also impact the team itself. So these are all the things to really think about as you think about how you best can work on your team, collaborate with your colleagues towards helping the people that you serve. Next slide, please. So that brings us to a really important thing. So knowing and understanding who the people are behind the walls in your team really means that you have to have a sense of your own positionality vis-a-vis the team. So I'm gonna turn this over to Pascal to talk a little bit about what we mean by that. So this also can answer the question that just came up in the chat box about things that can be helpful in discussion, right? In establishing a platform or an environment around having these dialogues. So positionality for folks that don't know and folks that have heard about it, right? Positionality is your identity, right? The multiple identities we ascribe to, who we are, how we show up, right? Giving a platform for me to talk about who I am, talk about and identify my, give my identities, right? As opposed to you just assuming, right? Which identities do I have that offer me power, privilege and disadvantages? And this is for each individual. So actually having each individual on your team talk about these things out loud. And how does our identities direct our perspective around the world around us? Now with this recent political climate and this current political climate, I mean, one of the things that, the word political is coded language as well too for let's not talk about anything that's going to make people uncomfortable. So anything that makes people uncomfortable, we coined it as the term political, right? And honestly, my identity drives who I am that can make it political. Being black can be political, right? Being white is political. So it can be anything that makes people feel uncomfortable, right? But if we don't talk about it, that continues to perpetuate the discomfort. So allowing to have the conversations, allowing people to express their identities, right? And what that means for them and creating brave spaces for that to happen. So if we could go to the next slide, please. So just to illustrate what that looks like for each of us, Hella, if you wanna tell us who you are. Yeah, thanks, Pascale. So I'm Hella and I'm a white woman. I'm a mother and I'm also a grandmother. My wife, I have a lot of different family relationship and I'm an immigrant. But as a white immigrant, it's a very different experience than BIPOC immigrants, people of color who come to this country. So my whiteness has allowed me to, can pass in a way people don't know only when you can hear my accent from time to time. But for the most part, I've had very different opportunities as an immigrant than other people on my team or in my community who come to this country from people of color. So that's a very different immigrant story that I have and that's how I show up on our team. Luis, who are you? Well, thank you for asking. So I am 100% Puerto Rican. I was born in the Bronx. So it's a term that Puerto Ricans developed back in the 60s. I am considered New York Rican. I'm New York Rican. So I am a man of color. There's a lot of African in me. There's a lot of indigenous Taino in me and there's a lot of Spaniard in me. Most Puerto Ricans could say the same thing. So I do see and feel and experience a lot of the challenges that my other brothers and sisters of color also experienced. I do have certain privileges. My tone is a little bit lighter and I hear Pascal when she talks about colorism because I seen it where people of color put other people of color down because of the tone of their skin or where they come from or things like that. And also I got certain privileges because of being a male. Being a male in a society like this one brings certain privileges. So I do identify some of my privileges and I do identify some of my history of oppression. So I'll stop there, Pascal. Okay. And for myself, I identify upfront as a black female, unapologetically black. I often say that very loud and clear because I feel like it is important to identify that for myself so that I have to remind, as a reminder of not having to camouflage my blackness in the rooms that I enter, considering that many rooms are predominantly white institutions and spaces. So it is very important for me to own that upfront. I am Haitian American. I'm a degree professional. So I have privilege that allows me to enter certain spaces, right? But also knowing that even though I have the privilege to enter those spaces, I'm still viewed oftentimes as less than just because of my appearance or even the tone in my voice and how I speak, which can often be narrated as aggressive. Unfortunately, it's just very passionate and it's not perceived as such, depending on how uncomfortable people are in the room with my presence. So when we're talking about positionality and talking about some of those things, that's just a little bit of me, right? But those are the things that come up front always because of having to constantly assert myself and assert my presence and be okay with my presence being in the room as well. So if we could go to the next slide, please. All right. And then for folks in the room, just to think about how do you show up at work? What are your identities that you put up front and what are the ones that you put behind that you don't necessarily often expose? That's food for thought and why, right? So again, there's so many identities that we carry. How do we show up at work and how does it translate in how we relate and provide services to the folks that we serve? All right. Next slide, please. Okay. So I'm establishing a vision here. Hela, I don't know if you wanna take this on. Can we go to the next slide, please? So I'm actually having a little hard time seeing my slides. Somehow something happened here. If you want us to jump in. Can you... Actually, can you... Something happened. I'm sorry. I had a computer problem before so I'm on somebody else's computer right now. So I can't really see the slide. Okay, I'll take it on. I'll take it on. Louis, feel free to jump in as well. So some of the questions that we have, this is something that probably can go Q&A or we can leave you with food for thought. What do you think is the first step to addressing inequality and inequality? How do you transform your work environment to address this? And how do we impact our community, right? For example, how do we work with local police to eradicate police violence against BIPOC? So these are some loaded, loaded questions. Where and how can you intervene to help facilitate a better process here? So now I can see the screen again. So thank you, Pascal. I think these are really what we have begun to really think about is the impact, how we as providers, as trainers, can really begin to examine how we work with local police and how we think about that in our work as behavioral health providers. So that is one I challenge us all to think about so that when people have mental health crisis that we think about the work leading up to that, but also what happens in that moment, how we as teams think about the work we do and whether or not how we include or not include the local police when we are addressing mental health crisis. Very important point that I think we as a community really need to think about very, very carefully. And as we all, I think, we sort of have a common practices for many people is that, or many agencies, many professionals, that if somebody calls them up in a crisis, that often says, if you can't reach me, call, and you have some kind of crisis, call 911. And that's one of the things that have often not led to good outcomes. So that is a very big challenge for all of us right now. We'll go to the next slide, please. So how do we go to a practice? How do we move further to take all again, these things, the understanding of social determinants, social determinants of structural racism, and how we all are in it. And how do we take that and begin to think about moving to an anti-racist practice? Next slide, please. So keeping it real, difficult conversations, and thinking through it. And again, Luis and Pascale, please join me here in talking about how we have begun to think about that as a team. Well, pretty much, and I know we're coming to an end too, so we need to begin to wrap up. But I mean, I think this was the first challenge we had, Hela, right? Because I think when we began to talk about these conversations, and this answers some of the questions that the audience has. Part of the questions that audience are asking is, well, how do you get people involved in having a discussion like this? I think you need to give people heads up. That's my opinion. If you ask me personally, you gotta give people heads up, right? Look, we are going to begin to have uncomfortable conversations. You need to be ready for this. Because when we are in that room, we're gonna be transparent. We're gonna be honest. We're gonna share our real thoughts. And even if we don't disagree, we're gonna talk about it, right? So this is what Pascal always coined as uncomfortable conversations. We have to have these uncomfortable conversations. And we did. We had a few, and we continue to have a few uncomfortable conversations, right? But the key is this. And now this is where all the trained counselors and trained therapists and trained social workers are gonna be very happy with me. That is not only the conversation that counts, it's the fact that you gotta process that conversation. You gotta spend time, and you gotta process that conversation. One of the things that we have done in the ACT Institute is that we spend one hour every two weeks. We spend one hour every two weeks processing things that happen during the week, right? And some topics take 30 minutes, 35 minutes, 40 minutes. Other topics take five minutes, right? But we come and for one hour, right? And it's early in the week too. It's not Monday morning. We wake up, we start in the week, and I go, okay, uncomfortable conversations are coming up. We're ready. We're ready. We know this is gonna happen. Many thoughts on that, Pascal. You said it, Luis. And making sure that we create the intentional space. Being intentional about doing the work. If you have set forth to make a decision that you want to do this work within your organization, within your team, being intentional and taking the time out to actually invest in doing the work. Not letting it be one response, the sole responsibility of the person of color and particularly in the group. And when we talk about difficult conversations and difficult challenges, being mindful of who the burden is left on in order to continue to have those conversations, especially when they're uncomfortable because they're uncomfortable for all. So, and being patient with one another and having the humanist, allowing opportunity for humanistic connections to happen because that will save us from those difficulties because there are some difficulties. And being responsible to do the work. Pascal, I wonder, and Luis, maybe we should jump to a few slides down to the model that we have that really was able to kind of do that. Since we also run a little bit out of time. Keep going. This one. So, this I think was really an important model that we followed. And this might be helpful to all of you who are interested in starting that. So, besides setting up a dedicated time, we also thought of really thinking that there were particular things that came up and we called them, we in our training spaces that we encountered where we began to notice something. Something happened that was, and we brought it back to our team and we began to discuss, reflect on it and named it that in that moment, that was an interaction that showed microaggression or implicit bias. And then we began to sort of dissect a little bit about what each of these moments, how does this content and content affect interactions in that moment? How did it impact us? What is the power dynamic that we noticed? What assumptions was kind of made by people in that interactions? And what larger societal structure power dynamics I impacted in this communication in that moment. And that moment can be in a training space, it can be on a team as you're having discussions or it can be interactions with the people that you serve. And so really having this framework and really the idea of looking at power dynamics but then what action can we take? What can we do? So what can we do to change things? So I think this model has been particularly helpful and if you go to the next slide, please, so this is a little kind of chart. We try to illustrate the process that we have gone through with these discussions that we have had. So we started in the summer of 2018 where we noticed these teaching moments. I'm gonna go across the bar here. We saw what happened on our ACT teams or within our team. We began sort of personal reflection. We say action with ACT, we work on in ACT. Then we looked at the organization that is levels and within our hospital where we work and our center. And then we began to think about how we could impact these discussions at more systemic level. So these are sort of the things we continue to do, the looking for moments that we can discuss with one another calling in and out as we calling in and beginning to address things with us. And then over time and the bottom box, lower right box is really what we begin to, how we've been trying to influence the tables, all the many tables that we sit at, both with people who are making policies about the way ACT should be delivered or within our own larger center and also the training that we develop and how we train. So this is kind of a way of kind of, again, an intentional way to have these conversations. They are hard, can be uncomfortable, but if they are not hard, we are not doing the work that we need to do. So that really sort of gives us a process in which you might move on some of the lessons learned from our work that we wanted to share with you. So, okay. So I see that Iruma is showing up. So that means that we are probably at the, towards the end. So we can kind of look at this and just to summing up that this is really within, towards this anti-racist practice that we are striving for, but with really trauma-informed perspective. So, okay, Iruma, we're gonna turn it over to you as our moderator. Thank you. And we're actually out of time, but it would be wonderful if you guys could share your email address. I know people are very excited. You guys answered some really good questions that came up. And if you could just provide people your email and also I believe we're gonna be sharing the slides if you guys are okay with it so that people don't have to wait. So I appreciate this, this was wonderful. Okay, so I think emails is at the very end of this PowerPoint presentation. So you could skip ahead and people might be able to see that. Great. So once again, thank you to our speakers for such an interesting, thought-provoking presentation. It was really, really wonderful. For those of you that are claiming continuing education credits for psychology or social work, please be sure to complete the evaluation at the end of the session. And if you're claiming continuing education, medical education for physicians, certificate of participation, you'll be able to do so at the end of the entire conference. So thanks again for joining us and take care, everyone. Bye-bye.

National Conference

Advancing Early Psychosis Care

United States

Inclusive Practice

Safe Spaces

Supervision

Interprofessional Teams

Structural Racism

Social Determinants of Health

Implicit Biases

Inequality and Inequity