You're Doing It Wrong: The evolution of cultural competence | Raquel Martin | TEDxRutgersCamden

Last week I left a training for my colleagues feeling a sense of exhaustion and frustration and this is not the first time I have felt this way. When I leave these trainings, I usually feel like they have doubled down on stereotypes instead of giving me Ways to address my biases and practice diversity and anti-racism

cultural

competency trainings are so prevalent these days and should be as we venture into a space to recognize, address and understand the impact that power, prejudice and privilege have on this world and on all those who reside in it, however, the truth is that normally when I attend these trainings I find that they are a waste of time and That is heartbreaking for me because we are worse off due to these poor trainings that do not give us ways to improve The Human Being.

Experience I am personally offended by these mediocre trainings because in the many roles I play I see the impact that poor

cultural

understanding, limited cultural humility, and outdated cultural knowledge have on the world. I see the impact as a teacher when my students come to me and I share that once again Val and the victims of racism have been invalidated by my colleagues at the Academy. I see the impact as a scientist when I look at statistic after statistic about the number of black patients and global majority patients who feel seen when they visit their doctors, these patients are much more likely to be misdiagnosed because the biases their doctors have affect your ability to make an appropriate assessment and do your job.

I see the impact as a licensed clinical psychologist when I work with patient after patient regarding ways to deal with the impact of the oppression they experience in the workplace, in their neighborhoods, and sometimes in their own families, and I see the impact As a black woman in America who often has to convince others that I am not a threat simply because of the color of my skin or the fact that my hair defies gravity. I see the impact every day. You know, a lot of people try to teach about cultural

competence

and the role of cultural

competence

without understanding the history behind the term.

Did you know that when I was a psychology professor? Dr. Daryl Wing Sue coined the phrase cultural competence and stated that it is not possible to fully know a group of people in a lifetime; It's true, he actually stated that it is more important to have experiential learning to interact with people who don't. We look like you, coming from different walks of life as human beings who focus on the academic trainings, the cognitive understanding that many of these diversity trainings seek to embody, but that is not how we are taught cultural competency, is that right? every year? we are required to attend at least one mandatory training most of the time it is in February we all know why it is usually in February and then we see a speaker, watch a webinar, check a box, get the certificate and with Too often, the education ends there, there are no afterthoughts, there is no follow-up, there is no experiential learning and that was never the way it should be.

When we treat cultural competence as an achievable goal, as a finish line to be crossed, we fail. completely and we commit injustice to all those. that will be significantly affected by our ignorance, our insensitivity and our thoughtlessness. Unfortunately, I have witnessed many incidents of poor cultural competence, but one that I always remember was during a panel, planning session between licensed clinical psychologists, the purpose of the session was to Identify ways to teach distress tolerance to a group of young black men. We generally do this by stimulating some form of stress that is considered reasonable and then allowing children to practice their coping skills in a safe environment.

This is usually done by showing a clip from a horror movie. but this year a psychologist proposed that they change the scene to a scene from the movie Crash that represented beliefs about police brutality, the attackers were European American police officers and the victims were a black couple. I want you to think about how abhorrent a decision it was for licensed mental health professionals whose job is to contribute to the mental healing of young people to decide that showing what they see police brutality depicting would create what is considered a reasonable amount of distress. and young black people I often wonder what contributes to this poor decision making. especially among licensed mental health professionals.

I believe this happens because the way we seek to understand and learn more about people from diverse backgrounds and cultures is limited to Zoom meetings, workshops, and webinars. I want to share some information with you so that I can help you completely. understand and humanize the experience of what a lack of cultural trust contributes to Black boys and girls being respectively three and six times more likely to be suspended from school than their European American peers for exhibiting the same behaviors in 2003. The Institute of Medicine published a 700-page document. Titled unequal treatment, this revealed that black patients have a higher mortality rate when it comes to heart disease, cancer, and HIV and AIDS than any other racial or ethnic group in the US and this disparity is not due to differences in access to care, in fact, at equivalent levels of access to care Black and Hispanic patients are significantly less likely to receive standard treatments known to treat medical disorders, including heart attacks, there is even disparity in level effectiveness of medical devices.

Pulse oximeters are used every day and hospitals to measure the level of oxygen in the blood are used for disorders such as pneumonia, lung cancer and asthma; However, a study conducted in 2022 revealed that they are less effective in people with dark skin pigmentation, such as black patients, the inability to adequately measure the level of oxygen in the blood can contribute to a number of medical difficulties and possibly death. death, a study with more than 4,700 participants revealed that black patients are more likely to be subject to dominant communication styles from their doctors, less likely to be provided with all treatment options, and less likely to participate in taking of participatory decisions for your own Health Care and if we go back to the development of the field of medicine we will find J Marion Sims, a man who is worshiped as the father of modern gynecology and who perfected his technique by operating on enslaved African women. without anesthesia and certainly without his consent.

I often see these things also therapeutic care. I want to put you in the driver's seat so you can understand how this can manifest in the therapeutic process. A patient comes to your office. A black woman walks in and she. she is seeking mental health care after conducting an assessment, you identify the fact that she is having difficulty identifying her strengths and abilities; She often feels like a fraud in her environment and is having difficulty achieving her goals, so they collaborate together to identify a plan. She decides to start assertiveness training, it's an effective treatment when it comes to anxiety and stress, but it doesn't work during the next appointment.

She shares that she has difficulty identifying the positive aspects of her life when she thinks about goals. about what she can achieve, she can't identify one, so you propose using a gratitude journal, but it doesn't work. During the next session, you probe further and she shares that she has never experienced this way of feeling like an imposter before. She usually thrives in all her environments and that's when you decide to empower her, you share that she simply needs to be authentic in her space and people will appreciate her obvious intellect in her vivacious personality and that's where you lost her, she goes with you and she you don't come back for another session now as a doctor in the room you do what anyone does when you are lost personally or professionally you wonder why what happened happened yourself you follow the steps yourself you use patient-centered care because your training taught you that very often black patients do not even participate in the treatment options that are simply given to them, you strengthened her and used a strengths-based perspective because you learned in your training that often black patients are treated from a deficit framework which is also detrimental, you did everything you were taught to do, but what you missed is what was not included in the training and what is often not included in the training because it seems to make others uncomfortable and that is the fact that when your skin is armed, everything is a privilege, authenticity is a privilege because everything can be perceived as a threat, from the tone of your voice to the way you wear your hair.

Did you know that black women were one and a half times more likely to know someone who was sent home for their hair or to be sent home for their hair and this is not limited to the workplace. Hair discrimination has been found in young people as young as five years old. They are creating an open and respectful world for natural hair. of legislation that was created by four phenomenal women who felt that black people should not be held down or discriminated against in the workplace and at school because of the way they wore their hair;

However, not even 50 percent of US states have enacted In fact, this legislation, although passed by the House in March 2022, was blocked in the Senate in December 2022. I want you to think about that for a second, how many times, when you think about privilege, do you think about authenticity when you take a step to reflect on that. I want you to ask yourself: did legislation ever have to be passed so that you wouldn't be retaliated against for the way you wore your hair, the way it grew out of your head, what's more authentic than that? Emphasize that the anxiety your patient felt probably could have been the result of stereotype threat.

This is a form of stress and anxiety that occurs when she is afraid of conforming to a stereotype that is attributed to her group. Now there are a lot of egregious stereotypes when it comes to black people, but a very common one has to do with a lack of intellect, if I'm working and stereotype threat arises, and it often does. I will create so much mental energy to combat that stereotype. I'm not stupid, I'm smart. Can. Do this, let me triple and double check that I won't even divert the correct amount of energy to accomplish the task that is within my ability, which will contribute to many more errors.

We all have stress when it comes to completing tasks. but stereotype threat gets in the way of you

doing

things that you can even do in general when you think about the integration of all the symptoms and what contributes to racism-related stress and difficulties within the environment. I want you to think about that. a tree that emphasizes that hesitation, that fear, that imposter syndrome that your patient was experiencing, which was a branch, but the things that contribute to that, the maintenance of those branches, thriving and whistling in the wind every day, is racism, those are the roots, if they ever want to improve people's human experience in general through all these trainings, they need to address the roots when you leave a training with the same mindset, the same information that you came in with to training with the problem is the training we need We vary the forms of information we advertise so many times we focus on peer-reviewed journals and those are a good start, but there is also publication bias.

It is easier to publish a research study that focuses on European Americans and one that focuses solely on black people or black people or people from the global majority and not, by comparison, one that focuses solely on these individuals and the complexities of the diaspora experience. We also need to look at the way we conduct these trainings. Are we analyzing intersecting identities? Skill level, sexual orientation, it seems like a lot to include it in a training and it is, and the goal is not to include it in a training. The purpose of this is to be an experience and understand that it is a journey when it comes to culture. competition we must focus on participation a talk of three hours and 15 minutes from q to is not enough time we need to look at books and break them down we need to listen to podcasts and break them down we need to really vary the information we offer Share the narratives that are experienced and the way in which people choose to share them and have a conversation.

Do you have difficulty keeping the conversation going? Do you feel uncomfortable? Let's start there. Where does the discomfort come from? Are you afraid of making mistakes? Alright. I would trust someone. Who admits to being

wrong

much sooner? I trustsomeone who says they are right all the time. Do you feel oppressed in the environment in which the training takes place? Let's start there. What form of oppression are you experiencing? Is it internalized? Is it institutional? It's cultural, all of these have different treatment plants, but they can all be achieved. We need to come back with tangible goals and metrics to achieve those goals.

It is not enough to say that we want the environment to be less oppressive. We need to say that we are. I'm going to review our policies and come back in two months and three months. Yes, your policy may state that you are against discrimination when it comes to skin color, but what about hair? What about hairstyles, hair length or protective styles that are attributed to certain people? from racial or ethnic backgrounds How diverse your company really is your organization When you move up different levels of the hierarchy, do you notice that individuals start to look the same?

That is not diversity and it is simply important to observe these things day by day. It didn't take a day to build that bias it's not going to take a day or what training to break it there is no such thing as being color blind when you say you don't see my color, you don't see me and it also puts emphasis on the

wrong

thing color is not the problem the Race is not the problem, racism is when we focus on what is really important, we can work to improve the overall human experience. and the many roles I play scientist psychologist person teacher I am here to tell you that therapy is not going to fix everything my office should not be the only safe space anyone has I should not have to manage the fear of people who took a Hippocratic Oath to protect me Those who decided to Serve and Protect others, the world should feel like a safe space and if we are going to address that, we have to look at the roots, we have to accept being wrong and we have to improve.

The overall human experience in understanding my cultural competence is not a finish line, we are going to work on this our whole lives, thank you.