When asking about preventative measures for a given health - PDF document

Disclosure Unpacking Microaggressions I have no relevant financial relationships with any companies related to the content of this course. and Biases and its Impact on Health Care Asian Health Symposium October 10, 2019 William Hua, PhD Staff Psychologist | San Francisco VA Health Care System Associate Clinical Professor | University of California San Francisco *Special Acknowledgement to Kelly Koo, PhD 1 2 “ When asking about preventative measures for a given health condition, a provider commented that “Orientals MICROAGGRESSIONS: rarely have that problem…” and suggested that “I shouldn’t Real examples from Asian providers and patients worry” (but did not elaborate further on my initial question). 3 4 1 | [footer text here]

“ “ I don’t have the range of affect that is ‘typical’ in western I was demonstrating a mindfulness exercise to a client and culture or the depth of expression expected to express his response to me was, ”It’s like you’re Mr. Miyagi from the extreme of emotions. Because of this, I am often asked Karate Kid.” I tried to take it as a complement since he did over and over again if I understood something, even enjoy mindfulness, but it was hard to knowing that he never though I repeatedly nod and say yes. remembered my actual name throughout our work together. 5 6 What are Microaggressions Microaggressions in Everyday Life ….and why does it matter? Microaggression Message Conveyed “Everyday verbal, nonverbal, and environmental slights, snubs, or § insults, whether intentional or unintentional, which communicate hostile, derogatory, or negative messages to target persons based § “Your English is good! You § You are a foreigner. You are solely upon their marginalized group membership.” (Sue, 2010) look exotic.” not American. § Locking the door when you § You are a criminal/you are see a person of color. dangerous. Microaggressions = occurs at individual, person to person, levels § “Do you have a girlfriend?” to Straight is standard; § § a gay man. heteronormativity. Microaggressions ≠ micro impacts § § Having just female or male on § Transgender persons as intake forms. “other” or as “not normal”. Microaggressions explained: Mosquito Bites § § “Can I speak to the doctor?” § Women are not doctors. to a woman doctor. ds Adapted from Sue et al, 2007 https://www.psychologytoday.com/us/blog/microaggressions-in-everyday-life/201011/microaggressions-more-just-race 7 8 2 | [footer text here]

Have you had a microaggression directed toward you in your role as a provider recently? A. Yes, in the past week B. Yes, in the past month Getting Personal C. No Pay attention to where microaggressions and individual and systemic biases occur in this narrative 9 10 Implicit Bias "I don't really work with a diverse population" § Multicultural humility as an Implicit (unconscious) bias : unconscious, APPROACH to clinical work, unintentional, and/or automatic mental process in which vs. tied to one identity. individuals may hold negative beliefs about others § Blindspots à bias E.g. having a general rule about not seeing a patient if they show up more than 10 mins late, but then being more likely to bend this rule if the client is ____ (often not in awareness) § Emphasis on approaches to working with the patient that includes: - Individual experiences - Intersectional Identities - Context - System Devine, 2012; Gaertner & Dovidio, 1986 11 12 3 | [footer text here]

Bias and Impact Impact on Health Care § Implicit bias is not inherently “bad”; we all have them, How does bias impact health care? even when we don’t want to believe that we do Interpersonal interactions (with patients) 1. § Because they happen on a subconscious level, want Treatment adherence - to examine what happens when biases remain Treatment follow-up/dropout - unchecked à Perception of quality of care - - Impacts our interpersonal interactions Internal dynamics (within the system, among staff) 2. - Biased decisions, unintentional slights Increase in microaggressions Costs/Waste (money, time) - 3. https://www.youtube.com/watch?v=ze7Fff2YKfM 13 14 Unpacking Bias and Its Impact Commitment to Action Discussion of Bias and Impact (15 minutes) § What is one action you will commit to that will help you to better examine and address your unconscious In groups of 4-5, provide as many examples as you can of bias that • bias? How can you help keep yourself accountable? providers might have about Asian patients who have a particular concern e.g. beliefs that Asian patients are less/more likely to smoke cigarettes) e.g. believing a patient would be healthier if they just ate less of their cultural food Discuss the possible impact of these biases on patient care • Strategies to Mitigate (5 minutes) Discuss strategies to identify the biases and better keep our biases in • check Debrief & Share (5 minutes) Pair with another group and briefly share what your group discussed • 15 16 15 16 4 | [footer text here]

Cultural Competence à Cultural Humility Cultural Competence Cultural Humility An ability to understand and interact “It is a process that requires humility in with people from various cultures and how physicians bring into check the belief systems; a skilled application power imbalances that exist in the of cultural knowledge dynamics of physician-patient communication by using patient- To Review Later focused interviewing and care.” (Tervalon & Murray-Garcia, 1998) “…is a process of openness, self- “One problem with this definitional approach is the assumption that awareness, being egoless, and cultural competence necessarily incorporating self-reflection and leads to efficacious outcomes when critique after willingly interacting with applied to minorities.” diverse individuals.” (Huey et al., 2014) (Foronda, Reinholdt, & Ousman, 2015) GOALS VALUES “I will apply this skill with my client” “I view learning as a continual process” “I will attend the Asian Health Symposium” “I commit to ongoing reflection on my biases” 17 Presentation Title 17 18 Implicit Association Task (IAT) Medical Bias and Impact Help to increase awareness of implicit biases that could § impact our work Medical Bias: Why Doctors Make Mistakes Measures strength of associations between concepts and § https://www.youtube.com/watch?v=8wlq7-v3-bc attitudes and beliefs that people may be unwilling or unable to report.” - E.g. “Belief that women and men should be equally associated with science, but your automatic associations could show that you (like many others) associate men with science more than you associate women with science.” “Results…show that members of stigmatized groups tend § to have more positive implicit attitudes toward their groups than do people who are not in the group, but that there is still a moderate preference for the more socially valued group”.” https://implicit.harvard.edu/implicit/ Devine, 2012; Gaertner & Dovidio, 1986 19 20 5 | [footer text here]

Resources References Devine, P. G., Forscher, P. S., Austin, A. J., & Cox, W. T. (2012). Long-term reduction in implicit race bias: A prejudice habit-breaking intervention. Journal of Experimental Social Psychology , 48 (6), 1267- Social Justice Syllabus 1278. https://www.div17.org/scp-connect/scp-news/scp-social-justice-syllabus/ Foronda, C., Baptiste, D., Reinholdt, M. M., & Ousman, K. (2015). Cultural humility: A concept analysis. Journal of Transcultural Nursing , 1-8. Diversity Toolkit: Guide to Discussing Identity, Power, and Privilege Gaertner, S. L., & Dovidio, J. F. (1986). The aversive form of racism . Academic Press. Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: attitudes, self-esteem, and stereotypes. Psychological Review , 102 (1), 4. https://msw.usc.edu/mswusc-blog/diversity-workshop-guide-to- Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. (1998). Measuring individual differences in implicit discussing-identity-power-and-privilege/ cognition: The implicit association test. Journal of Personality and Social Psychology , 74 (6), 1464. Greenwald, A. G., Poehlman, T. A., Uhlmann, E. L., & Banaji, M. R. (2009). Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. Journal of Personality and Social Psychology , 97(1), 17. One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Hays, P.A. (1996). Addressing the complexities of culture and gender in counseling. Journal of Populations Counseling & Development, 74 , 332-338. Huey Jr. S. J, Tilley, J. L., Jones, E. O., & Smith, C. A. (2014). The contribution of cultural competence to http://www.jointcommission.org/assets/1/6/hlconesizefinal.pdf evidence-based care for ethnically diverse populations. Annual Review of Clinical Psychology, 10 , 305-338 Sue, D.W. et al. (2007). Racial Microaggressions in Everyday Life: Implications for Clinical Practice. American Psychologist, 62(4), 271-286. Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2) , 117-125. 21 22 Thank You! 23 6 | [footer text here]