HEALS:AWorkshopforFacultyDevelopers

ÉlidaBautista,PhDAssociateClinicalProfessorDepartmentofPsychiatryEducationandTraining

Of>iceofDiversityandOutreach

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EricaMonasterio,MN,FNP-BCClinicalProfessorFamilyHealthCareNursingCo-ChairDiversityinActionSchoolofNursing

SOMEESSENTIALCONCEPTSunderstandingtheunderpinnings

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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

Micro-Aggressions:Examples

Micro-aggressions:Examples

Constantlyhavingyournamemispronounced

Beinginterruptedregularlywhenspeaking

Othersavoidingmakingeyecontactwithyou

Othersmultitaskingduringface-to-faceconversations(e.g.checkingemailsortexting)

Acknowledgingsomepeoplebutnotyouormembersofyouridentitygroup

Source:Ross,Howard.2014,pp74-75

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H*E*A*L*Soverview&exercises

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

Learn-Listentooneanother

Whatcanwelearnfromone

another’sexperiencesor

observations?

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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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HEALSCASESTUDIESSmallGroupPracticeSession

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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.

LARGEGROUPDEBRIEFCase#1

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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.

LARGEGROUPDEBRIEFCase#2

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HEALSCaseStudy#3

Thefacilitatorforaninterprofessionalstandardizedpatientexperiencehasdesignedaroleplayofaclinicalinterview,involving2students.OnestudentisintheroleofClinician,oneintheroleofParent.Duringthecourseoftheroleplay,studentsinterjectothercomments.

Breakupintogroupsof5-6.Usethescripthandouttostartthedialogue.Whetheryouhaveascriptedroleorarea‘bystander,’atanymoment,youmayadlibusingHEALStoHalt,Engage,Allow,Listen,andSynthesize.

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LARGEGROUPDEBRIEFCase#3

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LargeGroupDiscussion

•  HowwasyourexperienceimplementingHEALSinthescenariosyoupracticed?

•  HowwouldyouengagewithHEALSinyourrole:

•  asaFaculty?•  asaFacultyDeveloper?

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FormoreinformaEonpleasecontact

EricaMonasterio:ÉlidaBauEsta::

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