Post on 10-Dec-2021
HEALS:AWorkshopforFacultyDevelopers
ÉlidaBautista,PhDAssociateClinicalProfessorDepartmentofPsychiatryEducationandTraining
Of>iceofDiversityandOutreach
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EricaMonasterio,MN,FNP-BCClinicalProfessorFamilyHealthCareNursingCo-ChairDiversityinActionSchoolofNursing
Stereotyping
Theprocessbywhichpeopleusesocialcategories(e.g.race,ethnicity,sex)in:
• acquiring• processing• recalling
informationaboutothers.
IOM 2002
RisksofStereotyping
• Canexertpowerfuleffectsonthinkingandactionsatanimplicit,unconsciouslevel,evenamongwell-meaning,well-educatedpersonswhoarenotovertlybiased.
• Canin>luencehowinformationisprocessedandrecalled.
• Canexert“self-ful>illing”effects,asstudent/traineebehaviormaybeaffectedbyfaculty’sovertorsubtleattitudesandbehaviors.
IOM 2002
ImplicitorUnconsciousBias
• Socialstereotypesaboutcertaingroupsofpeoplethatindividualsformoutsidetheirownconsciousawareness(Fiske&Taylor,1991;Valian,1998)
• Oftenincompatiblewithourconsciousvalues• Allofusholdunconsciousbeliefsaboutvarioussocialidentitygroups
• Stemsfromourtendencytoorganizesocialworldsbycategorizing
• Mapstoexistingsocialhierarchiesandstereotypes(Nosek,2009)
AssessingandAddressingUnconsciousBias
• IndividualAccountability–Investigateyourownpotentialbias
• ImplicitAssociaEonsTest(IAT)• Self-discoveryinanon-threateningcontext
• Consciouslytaketheperspectiveofamemberofadifferentgroup(Galinsky&Moskowitx2000)
• Allowsuf>icienttimeasbiasisstrongerwhenundertimepressure(Martell,1991;Blair&Banaji,1996)
• Useyourself-awarenesstoacknowledgeandself-correctorcounterthein>luenceofUB
Micro-Aggressions
Briefandcommonplacedailyverbal,behavioral,andenvironmentalindignitiesandinsults
Communicatenegativemessagestotargetpersonsbasedsolelyontheirgroupmembershiporidentity
Typicallyoccurasaresultofunconsciousorimplicitbias
AlthoughtheINTENTmaynotbetoinsult,undermine,ordiscount,theIMPACToftenis
Source:Sue,&Capodilupo2008;NavarroandSalazar,USCFODO,May23,2016;
Micro-aggressions:Examples
Constantlyhavingyournamemispronounced
Beinginterruptedregularlywhenspeaking
Othersavoidingmakingeyecontactwithyou
Othersmultitaskingduringface-to-faceconversations(e.g.checkingemailsortexting)
Acknowledgingsomepeoplebutnotyouormembersofyouridentitygroup
Source:Ross,Howard.2014,pp74-75
H*E*A*L*S• Astructuredapproachtohelpcreatearespectfulandinclusive
environmentthroughproactivemeasuresandresponsivesteps
• Createdin2007forfaculty–withcards&suggestionsforuse• 2014-cardswithstudent-relevant“intro”
• A“communitynorm”intheSON• AllstudentsandfacultyreceivetrainingintheuseofHEALS
(includesexperienEaltraining)• HEALSisreinforcedinallSONsyllabiandthroughHEALS
CaseStudiesforfaculty• Of>iceofDiversityandOutreachwillbedevelopingtrainings
andtakingHEALScampus-wide… 13
Halt-thediscussion
Optionscouldinclude:
Pausetoconsiderthecomment,image,message…Youmightaskthepersontoclarifytohelpyouunderstandit.
Expressappreciationforraisingtheissue,providinganopportunitytodiscussanimportantelementofcare.
Focusontheidea-deconstructingthecomment,withoutplacingtheindividualwhomadethecommentonthedefensive.
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Engage-withtheissue
• Whois/couldbeaffected?
• Self-checkyourownresponse.• Checktheroom-lookforbodylanguage,
otherreacEonsofthestudents/trainees.• Gothere.Discusstheissue.
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Allow-tradingopinions/stories/perspecEves/arEcles/reacEons.
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• Letpeopleexpresstheirthoughts,beliefs,feelingsandexperiences
Synthesis-Whydoesthisdiscussionma_er?
• Relationtohealthequityandqualityofhealthcare• Howdidthisprocessofdiscussionwork?Allowforopportunitytotalkmorelater
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ImplemenEngH*E*A*L*S
• Morethanjustacard–needsasupportinfrastructure– Leadershipcommitment
– Trainedfaculty/stafffacilitators
– AccesstosupportandconsultaEonisessenEal• Addressessensitiveandcomplexinteractionalissues• Needtobemindfulofpowerdynamics• Takespractice,experienceandasenseofselfef>icacytoinitiate,especiallyinhierarchicalenvironments
• Peopleneedtimetoprocessandpractice
HEALS:AproacEveandresponsivestrategy
• TheadoptionanduseofHEALSrequirestheestablishmentofacommunityororganization-widenorm
• AllmembersmustbefamiliarwiththeHEALSModelandtrainedinitsuse.
• Student/traineeorientationsshouldincludeaHEALStrainingwithopportunitiestopracticethestepsinasafeandsupportiveenvironment
• AstatementabouttheuseofHEALSandareminderofthestepstotaketoaddressbiased,discriminatoryorexclusionarylanguageorbehaviorshouldbeincludedinallsyllabiandreviewedatthe>irstclassmeeting.
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BeproacXve:Setthetoneforyourclass
Giveadeclarationofexpectation.“Wearearichanddiverselearningcommunity.We’llhavemanydifferentperspectivestobringtoourdiscussions.”
Startthecoursebyestablishinggroundruleswithstudents–createatmosphereofrespectandsharedownership.Learnwhoisinyourclass“Wherehaveyoucomefromtogethere?”“Whyisitimportantforustoknowsomethingaboutoneanother?”AnticipateContentandDiscussionAreas“Today,wewillbefocusingon____.Thisisanareathatmaybringupdifferentperspectives.Iwouldliketocreatethespaceforallofustoshareandlistentoeachother’sideasrespectfully.”
AvoidPredictablePidalls
Anenduringandconsistentconcernvoicedbystudents/trainees
• TheonlytimeIseemyself/myfamily/mypeoplediscussedinthisclassisonlistsofriskfactorsorasexamplesofproblempatientswithproblematicsituations…
Theclassicapproachesofpresentingepidemiology,riskfactorsandcasesfrompracticemayallreinforcestereotypesandbiases
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ResponsiveStrategy:ImmediateResponse
• Stoptheconversation/lecture/presentation/sidebar
• UtilizethestepsofHEALS
Remember:WhileanyoneintheclassisinvitedandencouragedtouseHEALS,thepowerdynamicbetweenfacultyandstudentsmayprohibit
astudentfrominitiatingadiscussion.Itisultimatelyfacultyresponsibilityformaintainingarespectfulclassroomclimateforall.
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Frontallobe(prefrontalcortex)goesofflineLimbicsystem/mid&lowerbrainfuncXonstakeover
Thinking Brain
(Prefrontal Cortex)
Emotion Brain (Limbic System)
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(Ford, 2009, Van der Kolk)
J. Dorado (2015), UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH
Howdoyoureactwhenconfronted?
Brakes Accelerator
J. Dorado (2015), M. Merchant (2015) UCSF HEARTS, Child & Adolescent Services, UCSF/SFGH
• Mariëlle Coppes • www.magicaldaydream.com
IncreasingSelfAwareness
• Noticeyournon-verbals• PracticeSelf-regulation• Practiceself-forgiveness
• GiveyourselftheopEontoNOTaddresstheissueinthemoment
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ResponsiveStrategies:DelayedResponse
• H*E*A*L*Smaynotbeimplementedrightawayforavarietyofreasons–thisisOK!
• Notreadytoaddressitrightaway?– Icanfeelthatsomethingisn'tright,butIneedtoprocessitfirstbeforeinengagingindialoguewithyouallusingHEALS.CanIgetyourpermissiontoprocessit&comebacknextweektoaddressitusingHEALS?
• Wanttoaddresssomethingfromapreviousclass?– I'vebeenthinkingalotaboutlastweek'sclasswhenXXXXhappened…andI'dreallyliketotakesomeHmethisclasstotalkaboutitusingHEALS.
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HEALSCaseStudy#1
Youhaveaguestlecturerinaclinicalcorecourse.Shedecidesto“provideabreak”fromherlecturecontentevery45minutesbyincludingphotosandcommentaryabouthertravelsinAfrica,includingoneslikethosebelow:
HEALSCaseStudy#1
Asthefaculty,younoticeanumberofstudentsshiftingaroundintheirchairsandtalkingamongthemselvesduringthetravelslides,butsinceitisnotessentialcontentorevenrelatedtothelecturetopic,youdonotsayanything.
Thenextmorning,yourinboxhasanumberofemailsfromstudentsintheclass.
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HEALSCaseStudy#1-Emailfromstudent
“Likesomeofmyclassmates,Iwastroubledbythewaytheguestlecturerpresentedhervacationphotostotheclass.Iamsureshewaswellintentioned,andtheideatospiceupthelecturewithphotoswasnice,howeverthewaythiswasexecutedhadaprobablyunintendedeffect.Itfeltasthoughgeneralizationsweremadeaboutotherculturesofpeople(liketheMasaitribepeoplebeing'veryhappy'despitelivinginmudhuts),andphotosofpeoplefromdifferentcountrieswerepresentedasthoughthey,too,werescenery.Themostoffensivecommentshemadewas‘...IwenttoAfrica,thecountry,andtheydosleepinhuts.’”
HEALSCaseStudy#1-Emailfromstudent
“IcouldtellshehadnobadintenHons,buttheimpactwasthatitfeltabitobjecHfying...Becausetheguestlecturerwasnottakingstudentcommentsandtherewassomuchmaterialtocover,itfeltasthoughtherewasnoroominthelectureforastudenttocall'HEALS'orexpressdiscomfortwiththelanguagebeingused.Canyou,asourfaculty,pleasesaddressthisinthenextclass?ItisveryimpacLulonthelearningexperienceinthisclass!”
Break into groups of 4
You are the Faculty – Use HEALS to respond.
HEALSCaseStudy2
Youarethefacultyteachingacourseinclinicalmanagement,andintheinterestof“keepingitreal”,youalwaysusecasesfromyourpracticetohelpstudentsapplywhattheyarelearningtoreallifecasescenarios.Todayyouarediscussingchronicpain.Youusetheexampleofapatientyousawjustlastweek.Thecase,aspresentedinclass,follows:
MeetMr.Y
Mr.Yisa55yearoldhomelessmanwithchronicbackpainwho'sbeentakinganarcoticpainrelieverforthelastyearandahalf.Hecomesintodayandsays,“Somebodytookmyshoppingcartandallmystuffwasstolen–Ineedmorepainkillers.”Thisisthe3rdtimein6weeksthathehasrequestedare>illofhisnarcoticsearly.
Casestudy2cont’d.
Astudentraisesherhandandsays:
“I'vebeensittingonthisalongtime,andIfeelreallyuncomfortableandneedtosaysomething.ProfessorX,Ican'thelpbutnoticingthateverytimeyougiveanexample,itseemstofeedstereotypesaboutminoritypopulations…”
Small Group
You are the Faculty – Use HEALS to respond.
HEALSCaseStudy#3
Thefacilitatorforaninterprofessionalstandardizedpatientexperiencehasdesignedaroleplayofaclinicalinterview,involving2students.OnestudentisintheroleofClinician,oneintheroleofParent.Duringthecourseoftheroleplay,studentsinterjectothercomments.
Breakupintogroupsof5-6.Usethescripthandouttostartthedialogue.Whetheryouhaveascriptedroleorarea‘bystander,’atanymoment,youmayadlibusingHEALStoHalt,Engage,Allow,Listen,andSynthesize.
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LargeGroupDiscussion
• HowwasyourexperienceimplementingHEALSinthescenariosyoupracticed?
• HowwouldyouengagewithHEALSinyourrole:
• asaFaculty?• asaFacultyDeveloper?
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