Yale Psychiatry Grand Rounds: October 13, 2023

Transcript

• 00:00Morning everyone.
• 00:01It is great here to be here with you all.
• 00:04I'm just going to pull this slide up quickly.
• 00:08Actually let me do that once more just
• 00:09to make sure I got the sound on because
• 00:11you're not going to want to miss this.
• 00:12It's very key to hear the sound. OK.
• 00:31All right. So before we move forward,
• 00:33I just want to share that I don't have any
• 00:35relevant financial disclosures to report.
• 00:38So I'm so pleased to be here this
• 00:40morning with you all to share about
• 00:42the GROW program or the Getting
• 00:43Racism out of our Work program.
• 00:45I will just say right here at the top
• 00:47that all credit goes to Doctor Rebecca
• 00:49Miller for coming up with that incredibly
• 00:51beautiful name and aspirational name
• 00:53that I think describes the work of
• 00:56our initiative so, so perfectly.
• 00:59I will never forget when I walked into
• 01:03the shared office space that I had
• 01:06with my postdoctoral supervisor almost
• 01:0810 years ago now in Hartford, CT.
• 01:11I was working on a psychiatric
• 01:13inpatient unit for my full postdoc year.
• 01:16And I specialize in child and adolescent
• 01:18work, as you heard at the top.
• 01:20And I said to the supervisor in
• 01:22this tiny little cramped office,
• 01:24I said, all right,
• 01:25I'm going to head onto the unit so
• 01:27that I can see my first patient.
• 01:28You've already been onto the unit.
• 01:30Do you have any idea of where he might be?
• 01:32Have you seen him there?
• 01:34And without even looking up,
• 01:35she quickly threw over her shoulder and said,
• 01:39yeah, he's out there on the basketball
• 01:42court jumping around like a little monkey.
• 01:45Now,
• 01:46this patient of mine was under 10 years old,
• 01:50had experienced significant and
• 01:53perpetual familial and community trauma,
• 01:56and was psychiatrically hospitalized
• 01:58related to some of those experiences.
• 02:01And also that patient was black and
• 02:04the immediate rush of OK,
• 02:07did she really just call this patient
• 02:09a little monkey?
• 02:10Am I overthinking this?
• 02:12Am I overreacting?
• 02:13Maybe she didn't really mean that
• 02:15those questions started to populate
• 02:17to the front of my brain as they
• 02:19ordinarily would when she would
• 02:21make these kinds of remarks or
• 02:23engage in these kinds of behaviours.
• 02:25But there was something different as
• 02:26I started to walk toward the unit,
• 02:28A sense of dread that really,
• 02:30really hit me and that I will never
• 02:33ever forget.
• 02:33Because it was at that moment that I
• 02:36knew that what I had believed to be
• 02:38true about the supervisor engaging in
• 02:41this racist behaviour was in fact true.
• 02:43So two reasons why this happened to me.
• 02:45I think the 1st is that I had
• 02:47been socialized to question any
• 02:50experience of micro aggressions.
• 02:51That no, you are overreacting Amber.
• 02:54You are misreading that little off handed
• 02:56comment that that person might have said.
• 02:58You are blowing this out of proportion
• 03:00and that is part of the socialization
• 03:03to really disregard racist experiences
• 03:05that have happened and really allows
• 03:07them to perpetuate and proliferate.
• 03:09And the second reason I think this
• 03:11happened was out of self preservation.
• 03:13I really didn't want to believe
• 03:15that those experiences were in fact
• 03:17the experiences that I was having.
• 03:19So this morning I'm going to share
• 03:21with you about a program that
• 03:23without even realizing it,
• 03:25has been a program that in some ways I have
• 03:28developed for myself.
• 03:29That Amber 10 years ago,
• 03:31who really needed her supervisor to be
• 03:33able to have the knowledge and skills
• 03:36to confront some of these challenges.
• 03:38This program is for you and this program
• 03:41is for the next generation of people
• 03:43who come throughout our discipline.
• 03:45So in a lot of ways,
• 03:47this has been a corrective experience
• 03:48for me over the past couple of years.
• 03:50So the agenda is displayed here.
• 03:52I'm going to talk a little bit about
• 03:55the relevance of Grow's mission to our
• 03:57clinical and educational mission within
• 03:59our department and also what we think
• 04:01matches or mirrors the School of Medicine.
• 04:02I want to talk to people in
• 04:04the audience who might not be
• 04:06familiar with the GROW program.
• 04:07But for those of you who have
• 04:09been following our journey and
• 04:10have participated in the journey,
• 04:11want to share with you about the status of
• 04:13some of our current evaluation efforts.
• 04:15And then all together,
• 04:16we'll talk a little bit about the
• 04:18forming of the GROW initiative because
• 04:20we've really moved this beyond a
• 04:22curriculum program to really form
• 04:24what we think is something much
• 04:26bigger and talk about the future
• 04:28directions of the initiative overall.
• 04:29I'm going to try to leave some room for
• 04:32reflections at the end of this talk,
• 04:33as well as some questions.
• 04:34I'm going to quickly display the
• 04:36learning objectives for you here.
• 04:38You're able to see them elsewhere.
• 04:39I'm going to describe the context and
• 04:41development of this program to really
• 04:43help supervisors gain skills and
• 04:45knowledge regarding culture and diversity.
• 04:48I'll talk a little bit about some of
• 04:49the commonly cited challenges that
• 04:51folks encounter during the program and
• 04:52then some of the barriers of potential
• 04:55facilitators to try to incorporate
• 04:57these opportunities in the training
• 04:58that we provide and in in we in in
• 05:00the education that we think about.
• 05:02Now before I I go any further than this,
• 05:04I want to just make sure that I
• 05:07really note and acknowledge my
• 05:09two friends and also colleagues,
• 05:10both of whom are Co founders of
• 05:12the Grow Initiative doctors,
• 05:14Rebecca Miller and Cindy Crusto.
• 05:16I'm honored to be able to speak
• 05:17on behalf of our work together and
• 05:19I just want to make it very clear
• 05:21that this has been a collaborative
• 05:23effort through and through.
• 05:24We have met almost every single Friday
• 05:27morning for the the past several years.
• 05:29I'm pleased that they're both
• 05:30here this morning.
• 05:31They'll be able to support
• 05:32some of the Q&A toward the end.
• 05:34There are a number of other
• 05:35acknowledgements that I'll do at
• 05:36the end of this talk because this
• 05:38has really been an all hands on
• 05:40deck effort within the department,
• 05:42within the school and even within
• 05:45the university.
• 05:46So supervision has been called
• 05:47the signature pedagogy within the
• 05:49mental health profession and for
• 05:51good reason because it is a multi
• 05:54faceted and complex relationship.
• 05:55It serves as a mechanism for
• 05:57critical clinical governance,
• 05:58attainment of competencies
• 06:00and it's really a cornerstone
• 06:02of training, professional
• 06:03development and well-being.
• 06:04So a lot is happening in supervision.
• 06:07In this taxonomy of what
• 06:09makes exceptional supervision,
• 06:11it's really for when supervisors go
• 06:13above and beyond simply being qualified
• 06:15or having potentials in the discipline
• 06:17for which the Supervisee seeks training.
• 06:19But they're really engaging in some of
• 06:21these behaviours that you see displayed here.
• 06:22They're reliable and give clear expectations.
• 06:25They're monitoring clinical
• 06:26services to protect the public.
• 06:28They are collaborative and
• 06:30engage the trainee with humility,
• 06:33respect and flexibility.
• 06:34They are aware and attentive
• 06:36to power differentials.
• 06:38They really promote supervisees
• 06:39growth and development.
• 06:41And the thing that we're really going
• 06:43to highlight and zone in on today is
• 06:45they seek to learn and apply a deep
• 06:48understanding and respect of the supervisees,
• 06:51cultural identities as well as the
• 06:54clients served cultural identities.
• 06:56Now,
• 06:56even though supervision plays such
• 06:57a critical role in this discipline
• 06:59and this is information that you
• 07:01all already know,
• 07:02so I'll move through this with some pace,
• 07:04but do you want to just clarify that
• 07:06many training supervisors lack the
• 07:08fundamental knowledge and skill sets
• 07:10required to engage in culturally and
• 07:13racially responsive supervision?
• 07:15There have been national sets of data
• 07:17that have come forward in 2020-2021
• 07:20and well before that time where
• 07:22trainees are highlighting and crying
• 07:24out for these gaps in their own
• 07:27knowledge of race and culture as it
• 07:29relates to clinical practice and as
• 07:31it relates to just being people in
• 07:33the world and their supervisors as
• 07:34they're willing to bring it into supervision.
• 07:36And it won't surprise you that
• 07:39those implications and that that
• 07:41experience is really amplified among
• 07:43reports of trainees of color.
• 07:45So often times trainees are reporting,
• 07:47experiencing or witnessing instances of
• 07:50identity based harassment and discrimination
• 07:52within the trainee supervisory dyad,
• 07:54as well as within their clinical care
• 07:57settings that these things often
• 07:59recur and often times go unaddressed.
• 08:01Think about the sort of professional
• 08:03risk and raising to your supervisor.
• 08:05You know that that didn't sit right with
• 08:07me or that didn't sit well with me.
• 08:10When this happens,
• 08:11trainee satisfaction suffers,
• 08:13And you might say to yourself, well,
• 08:14trainees are not here to be satisfied,
• 08:16and partly that that might be true.
• 08:17But here's what else suffers?
• 08:19Clinical practice suffers.
• 08:21Trainees lose confidence,
• 08:23and this is shown in the literature in the
• 08:25clinical services that they're providing.
• 08:27They are less willing and they are more
• 08:29hesitant to raise critical patient
• 08:31issues within supervision to get the
• 08:33guidance that is needed and necessary.
• 08:35And their professional development suffers,
• 08:37including whether or not they
• 08:39choose to remain in the field.
• 08:42I sat on the front porch of my apartment
• 08:45almost 10 years ago here in West Hartford,
• 08:48and I remember a phone call to
• 08:49my dad where I said to him,
• 08:50Dad, I think I have to quit.
• 08:53I don't think I can go back to
• 08:55that placement one more day.
• 08:57So I thought very seriously about quitting,
• 09:01and that would have been years
• 09:03of really pouring into all of the
• 09:04work to try to get to this place.
• 09:06And if we are trying to change the
• 09:09composition of our discipline to really
• 09:10reflect what looks like the world,
• 09:12this has devastating potential
• 09:14implications for that work.
• 09:16So the bottom line here is that
• 09:18these gaps in knowledge can cause
• 09:20harm and training is an imperative.
• 09:22So we've heard about these data nationally.
• 09:24I'm going to flash before you some of the
• 09:26data that we've seen here within our own
• 09:28psychology doctoral internship program,
• 09:30the Diversity,
• 09:31Equity and Inclusion program,
• 09:32which was Co founded years ago by Doctor
• 09:35Cindy Crusto and Doctor Jack Teebs.
• 09:38It was really supported in an overarching
• 09:40way by some of the work that Michael
• 09:42Hogey had done in his role as Director
• 09:44of the training program in bringing
• 09:45in the diversity concentration,
• 09:47was doing comprehensive quality
• 09:49improvement work and really to look and
• 09:52examine about the climate related to
• 09:54culture and diversity in our training
• 09:56program and in regards to supervision.
• 09:58So in 2019 and 2020,
• 10:00what we found is that trainees were
• 10:01in the same way that we saw in
• 10:03that national literature reporting
• 10:04these perceived gaps in knowledge.
• 10:06So I want supervisors to have more
• 10:08training and issues regarding DEI.
• 10:10Supervisors are engaging in microaggressions
• 10:13with patients and with fellows.
• 10:15The next year,
• 10:17what we saw was very similar findings,
• 10:19but a different thing happened
• 10:21for us in the internship program.
• 10:23Typically,
• 10:23trainees will report moderate to
• 10:25high levels of satisfaction overall
• 10:27with the climate,
• 10:28and they would talk about some of these
• 10:31nuanced changes or nuanced challenges
• 10:32that they were experiencing that they
• 10:34would want to perhaps be different.
• 10:36This year,
• 10:37half of the trainees actually reported
• 10:40being dissatisfied with the training
• 10:42experience in regards to culture,
• 10:44and what was different about
• 10:45it was not the knowledge gaps.
• 10:47Those still persisted,
• 10:48but trainees started to report
• 10:50on their subjective distress in
• 10:52the face of those knowledge gaps.
• 10:55So trainees reported that supervisors were
• 10:57not acknowledging racism and power dynamics,
• 10:59that they were engaging in
• 11:01microaggression and assumptive behaviors.
• 11:03And then finally,
• 11:04there was this experience of a feeling
• 11:06disheartened about the the perception
• 11:08and consistency right in terms of how
• 11:10the program was responding to some of
• 11:13its own cited values and initiatives.
• 11:14We saw the same kinds of things
• 11:17reflected when we asked specific
• 11:19questions about supervisors
• 11:20theoretical and empirical knowledge.
• 11:22So not just what is the climate,
• 11:24but when you're in supervision,
• 11:25how much do you feel that your supervisor
• 11:27is helping you to refine your own
• 11:30theoretical and empirical knowledge?
• 11:31And to what extent are these
• 11:33issues being raised in supervision?
• 11:35So trainees talked about this idea that
• 11:37sometimes this modelling is happening,
• 11:39but we want to have direct,
• 11:41explicit conversations.
• 11:41Another thing that was interesting is
• 11:44that these discussions were a lot less
• 11:47likely when both the supervisor and
• 11:49Supervisee Diad both identified as white,
• 11:51and those knowledge gaps of course persisted.
• 11:55So at the same time,
• 11:57when supervisors who are themselves
• 11:59clinical leaders often are able to
• 12:01engage in racially and culturally
• 12:03responsive supervision, everybody wins.
• 12:04You see displayed here some of
• 12:07the key supervisory skills and
• 12:09characteristics that capture racially
• 12:12and culturally responsive supervision.
• 12:14Supervisors are self aware.
• 12:15They think about power and privilege
• 12:17inherent to the role of the supervisor.
• 12:20They are open and willing to engage
• 12:22in these direct critical discussions.
• 12:24And then the benefits of trainees are
• 12:26almost the opposite of what we see.
• 12:27Some of those challenges being
• 12:29that trainees actually report
• 12:30feeling more confidence in their
• 12:32clinical skills and abilities.
• 12:33They're more willing to disclose
• 12:35and get needed support.
• 12:36They have positive professional
• 12:38development attitudes.
• 12:39So this is really the data that
• 12:42sits behind our thinking of putting
• 12:44together this initial offering.
• 12:46So I'm going to use Kern's six
• 12:49step curriculum development as
• 12:50an overarching framework here.
• 12:52I'll just refer to it once,
• 12:53but I'm going to really step you through
• 12:55the process of how we put together our pilot.
• 12:57So you just heard about the problem
• 13:00identification that happened over 2 years,
• 13:02was rooted in the literature,
• 13:03was rooted in a lot of our data.
• 13:05And what we found was that we
• 13:07were hearing a lot from trainees,
• 13:08but in our targeted needs assessment,
• 13:10which was the next step.
• 13:11We really wanted to hear from our faculty.
• 13:13What do they say they need,
• 13:15and do they agree or disagree?
• 13:17And in if so, in what ways?
• 13:20So Becca,
• 13:20Cindy,
• 13:21and I really put our heads together.
• 13:23We were really thinking about a lot
• 13:24of what had been done previously
• 13:26in the DEI committee,
• 13:27and we developed a targeted
• 13:28needs assessment to really try
• 13:29to understand things further.
• 13:31So we asked the faculty of our
• 13:33psychology internship program at that
• 13:35time to just report their understanding,
• 13:38knowledge and comfort level,
• 13:40discussing various concepts and identities.
• 13:42And we also asked them to rate what
• 13:44are the topics that you feel that you
• 13:46are most interested in learning about
• 13:48and that you would find post high yield.
• 13:51And what you see displayed here,
• 13:52I think largely reflects what you
• 13:54just heard about the top topics.
• 13:5794% of our respondents,
• 13:59we had 34 completed surveys out
• 14:01to 76 supervisor said,
• 14:03I want to know how to discuss
• 14:04race and racism.
• 14:05I want to know how to do supervision
• 14:07with different race and ethnicity dyads,
• 14:08how do I support my trainee who
• 14:10experiences race or racism in
• 14:12the context of clinical services?
• 14:14Another theme that sort of arose
• 14:16in some of the qualitative data out
• 14:18of that survey was how do we manage
• 14:20racist information that we hear about
• 14:23other supervisors from our supervisees.
• 14:27We also did a revised version of the
• 14:29Multicultural Supervision Inventory,
• 14:31which was originally developed to ask
• 14:34Supervisee perceptions of their supervisors.
• 14:36And we refined it and adjusted it
• 14:38because this is a little bit wild,
• 14:40but there aren't very good empirically
• 14:43validated measures asking for
• 14:45supervisor assessment of their own
• 14:47perceptions. And even of those,
• 14:49those surveys themselves have
• 14:51some biased language in them.
• 14:53So Doctor Miller did an incredible
• 14:54job of of crafting something so that
• 14:56we could really get a clear sense.
• 14:58And what we found out of these two data or
• 15:01out of these data points were that when
• 15:04we thought about supervision strategy.
• 15:06So I encourage my supervisees to think
• 15:09about cultural issues when working with
• 15:11clients and multicultural knowledge.
• 15:13These were the two things that arose
• 15:17as rated much lower in terms of
• 15:19faculty's confidence and competence.
• 15:21Discussing these things in supervision so
• 15:23knowledge would be knowledgeable about
• 15:25groups who are different from me culturally.
• 15:27So we knew that we were really on to
• 15:29something in terms of thinking about
• 15:32knowledge and also skills incorporation.
• 15:33So the goals and desired outcomes of
• 15:36our pilot were pretty simple, simple.
• 15:38We wanted to give faculty a similar
• 15:42foundation, language,
• 15:42and knowledge of current research
• 15:45and best practices.
• 15:46But we didn't want faculty just
• 15:48to learn theoretical knowledge.
• 15:50We wanted them to learn personal
• 15:51knowledge about culture and diversity.
• 15:53So who am I as a cultural being in this
• 15:56work to improve their supervisory practices?
• 15:59We wanted to increase their ability
• 16:01to incorporate these skills within
• 16:03their supervision and teaching
• 16:05so that they could improve their
• 16:07supervisory practices overall.
• 16:08So we wanted to proactively help
• 16:11folks address training experiences
• 16:13of racial bias and increased ability
• 16:15to address racism in clinical care.
• 16:17Another goal that you don't see listed here,
• 16:19but that was certainly there is using
• 16:21a lot of these data and leveraging
• 16:23them within the internship program
• 16:25to make improvements.
• 16:27And then as you'll see when we
• 16:28get to grow two point O,
• 16:29we really expanded that beyond just our
• 16:31own internship program and wanted to
• 16:32participate in a national conversation
• 16:34and into the national model around how
• 16:36we can get this done across the discipline.
• 16:39So just to Orient you to some of how
• 16:43we arrived at the specific program
• 16:46that you're going to hear about.
• 16:47We had our general and targeted
• 16:49needs assessment data,
• 16:50but we also had a number of
• 16:52collaborations and consultations.
• 16:53So we used our our collective subject
• 16:56matter expertise really took a deep
• 16:58dive into the literature and also
• 17:01collaborated with the the School of Medicine,
• 17:03Clinical Research and Education Librarian
• 17:05team to make sure that we had the most
• 17:08contemporary research in that regard.
• 17:10We developed a proposed
• 17:11structure of the curriculum.
• 17:13And then we had a series of focused
• 17:15consultations with the experts at the
• 17:17Porvu Teaching and Learning Center
• 17:18to really help us think about the
• 17:21curriculum design to make sure that it
• 17:23included inclusive teaching practices,
• 17:24was responsive to participants at varying
• 17:27levels of starting knowledge and foundation,
• 17:29and that it was really going to align with
• 17:32some of the outcomes that we had identified.
• 17:35We also didn't.
• 17:36What I've learned is called
• 17:37designing at the whiteboard,
• 17:39which is where you basically
• 17:41have this amazing idea.
• 17:42You wipe, I have a whiteboard in my office.
• 17:44You put it all in this whiteboard,
• 17:45you go out and you build it
• 17:46and then nobody comes to it.
• 17:48We wanted to make sure that we
• 17:49were engaging with key stakeholder
• 17:51groups that we knew we were
• 17:53building this for so that we could
• 17:54make sure that people would come.
• 17:55If you, if you build it,
• 17:57they will come type of vibes.
• 17:58So within the psychology internship program,
• 18:00we liaised with the DEI committee.
• 18:03We had many conversations with
• 18:05the Executive training committee,
• 18:06which is the governance body
• 18:08of of the internship.
• 18:09We had conversations with our internship
• 18:12core faculty did presentations on
• 18:14those data that you yourself just saw
• 18:16and really sought to get people's
• 18:18feedback about what what kinds
• 18:20of things would be highest yield.
• 18:22We also had consultation within
• 18:24the residency and the department.
• 18:26So had some really I think impactful
• 18:29conversations with the long term
• 18:31care clinic residents or or long
• 18:33term care clinic leadership,
• 18:34the psychiatry residency leadership,
• 18:37which we're really I think fruitful.
• 18:39Those discussions happened at the
• 18:41very beginning of our efforts
• 18:43and also our education faculty
• 18:45and clinical subcommittee,
• 18:46Co chairs of the ARTF were also
• 18:49invited to be participant observers
• 18:51to the curriculum materials online,
• 18:54provide feedback and to really think
• 18:55about whether there were synergies
• 18:56with the work that was happening
• 18:58or the recommendations that would
• 18:59be coming out of those committees.
• 19:00So we really tried to think broadly.
• 19:02I'm going to show you now there's
• 19:04there's no sound for this.
• 19:05I'm just going to narrate over it.
• 19:06But one of my biggest pieces is
• 19:08to really get, hi,
• 19:09I'm Becca Miller and I'm the
• 19:10Co chair of the Diversity,
• 19:12Equity and Inclusion Committee.
• 19:13And I'm so excited to offer you this
• 19:15curriculum that we've put together.
• 19:17This curriculum is really built
• 19:18on the work and accomplishments
• 19:20of the DEI committee,
• 19:21which was not just rely
• 19:22on information in emails,
• 19:24not just rely on information in
• 19:27bulletins or journal articles,
• 19:28but to really think about how
• 19:30we're actually recruiting.
• 19:31And so this was one of our strategies.
• 19:33We had a professionally developed video
• 19:35by Doctor Cindy Christo and Doctor Jack.
• 19:38Some of the accomplishments of
• 19:40the committee include things like
• 19:42bringing more DEI focused Grand
• 19:43Round speakers to the department,
• 19:45offering opportunities for supervisors of
• 19:47color to connect with trainees of color.
• 19:50Looking at what DEI offerings are in
• 19:53our seminars, in our clinical work,
• 19:55in our supervision and really making
• 19:57sure that we're meeting the needs of
• 19:59our trainees and training the best
• 20:01next generation of psychologists,
• 20:03the Diversity Equity and Inclusion
• 20:05Committee really began.
• 20:06OK, so you've already seen enough of me,
• 20:08but there's a teaser there.
• 20:10If you're interested to see this
• 20:12longer fuller video,
• 20:13please do get in touch with me,
• 20:14I'll,
• 20:14I'll let you know what that looks like.
• 20:15But that's that's a theme that
• 20:17you'll see throughout as we really
• 20:18tried to think about how do we,
• 20:21how do we engage our stakeholders differently
• 20:24to the some of the usual methods.
• 20:27All right, So what were the core design
• 20:28principles for the curriculum itself?
• 20:30And I promise you,
• 20:31I'm going to tell you about the curriculum,
• 20:32but really want to share with you the,
• 20:34the complexity of the thinking that
• 20:36went behind what you're going to see.
• 20:37We wanted to make sure that
• 20:39the learning was planful,
• 20:40sequenced, graded in complexity.
• 20:42So really thinking about evidence
• 20:44based approaches to teaching,
• 20:46we had expected competencies and learning
• 20:48objectives that were clearly clearly
• 20:50defined and assessed at multiple points.
• 20:53We wanted faculty to play an active role
• 20:55in self reflection and assessment so
• 20:57that they could identify their strengths,
• 21:00their personal learning needs
• 21:01and objectives and allow some of
• 21:03this work to be learner driven.
• 21:05We also wanted to reduce the burden
• 21:08on our internal subject matter
• 21:10experts who are often called upon
• 21:12to do this work repeatedly.
• 21:14But we also knew that that was
• 21:16important for us to bring in external
• 21:18people to reduce that burden,
• 21:19but also to facilitate some of the honest,
• 21:22difficult and I think ultimately
• 21:24transformative discussions that
• 21:26would be so key to having this work.
• 21:28We also wanted people to be able
• 21:29to learn in community.
• 21:31So if we're asking people to
• 21:32learn something about themselves,
• 21:33part of that immersive experience is
• 21:35being within and among your colleagues.
• 21:37And so we wanted to make sure that
• 21:38there was immersive discussion
• 21:40and engagement with faculty peers
• 21:41moving beyond that content knowledge
• 21:43to personal knowledge.
• 21:44And then practicality was something
• 21:46that we consider deeply,
• 21:47and it's certainly not something
• 21:48that we have solved for entirely,
• 21:50But we wanted to be thoughtful
• 21:52about time commitment.
• 21:53We wanted to be thoughtful about flexibility,
• 21:55so synchronous and asynchronous
• 21:57learning opportunities.
• 21:58And then we also thought about incentives,
• 22:00so continuing education credits,
• 22:02branded items and books research
• 22:04and professional development funds.
• 22:07I I actually eliminated our quarterly
• 22:09core training faculty meeting in
• 22:12lieu of having these trainings.
• 22:14So really trying to be thoughtful
• 22:16around that.
• 22:17We started this out on an incredibly,
• 22:21an incredibly small budget and we're
• 22:22so grateful to have been sponsored
• 22:24originally by the American Psychological
• 22:26Association and matched by the department.
• 22:29But when I say very small C grant,
• 22:30I mean $7000.
• 22:31That is how we started this program
• 22:33that you're going to see before
• 22:34you and we have really grown and
• 22:36developed this much, much further.
• 22:38But this is what we were able to get done.
• 22:40We also were able to secure some
• 22:42additional small funds from the
• 22:43teaching and Learning Center and
• 22:45then we collaborated with Dean
• 22:47Lattimore within the office of DVI.
• 22:50So the pilot curriculum is what you see here.
• 22:52It had four core content domains each
• 22:55drawing on three major elements.
• 22:57So the first were core workshops,
• 23:00the second was Co small Co learning
• 23:02groups and the third were self-paced
• 23:04supplemental offerings.
• 23:05So the content domains that you see
• 23:07there are really aligned with this
• 23:09idea of getting foundational knowledge,
• 23:10skills integration.
• 23:11And then the final two domains
• 23:14really try to amplify 2 specific
• 23:17areas of content knowledge,
• 23:19so intersectionality and
• 23:20structural competence.
• 23:21So the program was designed
• 23:23to be highly interactive.
• 23:24There were two to our live virtual
• 23:27workshops that were delivered by external
• 23:29subject matter experts who we reached
• 23:31out to people all across the country,
• 23:33met with every single one of
• 23:36those people individually.
• 23:37There was, there was perhaps over 20 or
• 23:4025 different contacts that were made.
• 23:43We wanted to make sure that
• 23:44structurally the curriculum
• 23:45was delivered at a good pace.
• 23:46So the intention was to have it
• 23:48go over about six months with
• 23:50those core seminars or those core
• 23:53workshops about every other month.
• 23:55And participants received
• 23:57electronic reminders.
• 23:58They had the ability to log into Canvas,
• 24:01which was the learning tool that we
• 24:02used to make sure that they had access
• 24:04to all the supplemental materials.
• 24:05And I'll show you that here in just a second.
• 24:08We had small Co learning groups
• 24:09because as I said at the top,
• 24:10we wanted to make sure that
• 24:12there was peer community and
• 24:13immersive discussion opportunity.
• 24:14So as we had,
• 24:15you know a large group of people
• 24:17coming together for content knowledge,
• 24:18we wanted people to have
• 24:20that process opportunity.
• 24:21But we made these optional just because
• 24:23we were trying to really get a good
• 24:24sense of what was going to work well.
• 24:26But we did design A workbook
• 24:28to really guide people through
• 24:29some of those initial stages,
• 24:31with recommendations about how
• 24:33they could form their groups,
• 24:34recommended materials for them to read,
• 24:36and then certainly guidance about
• 24:38different questions or prompts that
• 24:40they might talk to each other about.
• 24:42But we didn't. We didn't sort of prescribe.
• 24:44This is what you'll what you'll do.
• 24:47This is don't break out a microscope.
• 24:49This is a glamour shot of
• 24:51our learning objectives.
• 24:52You're not intended to read these.
• 24:53I just want you to know that
• 24:54they are exist and that they're
• 24:56anchored in the literature.
• 24:57Here's zooming out on 2 examples
• 24:58of the learning objectives from
• 25:00the practical application domain.
• 25:02So skills,
• 25:02integration.
• 25:03Can you identify 3 strategies to
• 25:05manage the challenges and anxieties
• 25:07related to discussing race and
• 25:09forms of racism and supervision?
• 25:11So that would be an example of one
• 25:13of those concrete learning objectives
• 25:14that we had for faculty in that pilot.
• 25:17A couple glamour shots of
• 25:19the workbook for the pilot,
• 25:21just to really show you here.
• 25:22You're not intended to be able to read this,
• 25:24but this is our really original
• 25:27workbook and as you can see here,
• 25:29this was largely learner driven,
• 25:30so there were open-ended questions.
• 25:32Participants were really intended
• 25:33to guide their own learning with
• 25:36recommendations about prompts and
• 25:37different book chapters from us to read.
• 25:40So what you're going to see here now
• 25:42is a sneak peek of the Canvas website
• 25:44that was designed in collaboration
• 25:45with the digital education team at
• 25:47the Teaching and Learning Centre.
• 25:49So we had
• 25:51our our our professionally
• 25:52developed video that was here.
• 25:55Faculty were also given a special
• 25:56video to walk them through how to
• 25:59use the Canvas paging website.
• 26:00They were able to see the
• 26:02full curriculum and schedule,
• 26:03but we also wanted them to know who
• 26:05the subject matter experts were that
• 26:07were coming into our space to talk to
• 26:09us and we wanted them to get a good
• 26:11sense of the caliber and level of
• 26:13national expertise and international
• 26:14expertise I would say that folks had.
• 26:15So you can see there that it was
• 26:17linking out to different websites,
• 26:19making sure that people had a good
• 26:21understanding of what the learning
• 26:22objectives were as well as a summary
• 26:24of each one of those sessions.
• 26:26There were also discussion
• 26:27boards that were available for
• 26:29people to use if they so chose.
• 26:31And you can see here again just
• 26:33where people are able to go in and
• 26:35access some of that supplemental
• 26:36content and what that might have
• 26:38looked like for a user in the pilot.
• 26:42We also had additional supplemental
• 26:44opportunities where we had an art tour,
• 26:47we had, there were video screenings
• 26:48that happened that were optional
• 26:50for folks to participate in.
• 26:51So you see here just a long running
• 26:53list of different materials
• 26:54made available to faculty.
• 27:00So enrollment we had about 44 folks
• 27:03enrolled and in the beginning as I said
• 27:04this was really targeted toward the
• 27:07psychology doctoral internship program.
• 27:08So the bulkhead of folks were
• 27:10coming from that program,
• 27:10but because we were really thinking about
• 27:13this as something that would that would
• 27:15scale up to the department more broadly.
• 27:17We were already having key conversations
• 27:19with the psychiatry residency
• 27:21leadership and together we identified
• 27:23a representative from each one of the
• 27:25clinical institutions to come and pilot
• 27:27the the program and give us their
• 27:30feedback back about the program and
• 27:32what perhaps if anything might need to
• 27:33be changed if we were to scale this up
• 27:35to the psychiatry residency faculty as well.
• 27:37We also had some really incredible
• 27:39participation from the long term care clinic.
• 27:40We actually came away with a wait list from
• 27:44the LTCC after we did that original pilot.
• 27:47You'll see here just some brief demographics
• 27:49that in large part the folks who came
• 27:51forward for the pilot reflect in many
• 27:53ways the composition of the department.
• 27:55We had a number of folks who were
• 27:57actually actively teaching within
• 27:58the psychology internship program and
• 28:00almost everyone who participated was
• 28:02engaging in individual supervision,
• 28:04at least of psychology or
• 28:07psychiatry trainees.
• 28:08So, but here is some workshop data.
• 28:11After each one of those live workshops
• 28:14we assessed to what extent did faculty
• 28:17find the workshop to be high quality,
• 28:18To what extent did they learn A lot,
• 28:21to what extent were they satisfied?
• 28:22And what you see here on a scale of one
• 28:25to five with five being the highest,
• 28:27is that overwhelmingly we had
• 28:29really positive feedback.
• 28:30And you'll have to remember that this
• 28:32was a voluntary group of people that
• 28:34were coming forward who said we want
• 28:36to learn about these issues and they
• 28:38were also saying like and we're finding
• 28:40them to be really high yield seminar.
• 28:41So you'll even see that the ratings
• 28:44increased throughout the sessions,
• 28:45particularly session 1:00 to 2:00
• 28:46because we were taking in feedback
• 28:48real time and making adjustments to
• 28:50those sessions as we went through.
• 28:52You will note that the attendance
• 28:54does start to a trip here and I'll
• 28:56talk a little bit about that when
• 28:58we get to a further slide.
• 29:00We did reassess some of those
• 29:02different domains of multicultural,
• 29:04supervisory behaviours.
• 29:05And what you'll find,
• 29:07what you'll see here is that we had really,
• 29:09really low response rates for
• 29:13our post program participants.
• 29:15So we had sixteen of our 44 folks
• 29:17actually fill out that survey.
• 29:19We also sent it out to a group of controls
• 29:21and we had only 11 people respond back.
• 29:23So we weren't able to do any
• 29:25statistical analysis or comparison.
• 29:27But what you will see here are
• 29:28mean scores and while they're not
• 29:30significantly different or they're
• 29:32not different in appearance from
• 29:34our our participants in the group,
• 29:37I'm going to show you some qualitative
• 29:39data that actually is discrepant from
• 29:41this and we'll just bookmark this here
• 29:43and know for the for grow two point
• 29:44O that we're going to try to have
• 29:46a much more robust evaluation,
• 29:47but I just wanted to show you that data.
• 29:50Here's where the really
• 29:51rich feedback came from,
• 29:52a lot of informal conversations but
• 29:54also formal assessment of supervisors
• 29:56perceptions and experiences.
• 29:58So the qualitative feedback really matched
• 30:01those high ratings for the workshops overall.
• 30:05And the qualitative feedback about
• 30:06the program overall was very similar.
• 30:08So we were hearing things like this
• 30:10material was rich and relevant.
• 30:11The session helped to convey
• 30:13confidence about the ability of
• 30:15supervisors to address these issues
• 30:17as they impact supervision.
• 30:19There was a positive theme and
• 30:20report of people being able
• 30:22to really engage in role play,
• 30:23so I felt like I was building actual
• 30:26skills and applying those concepts.
• 30:28Super supervise or presenters I should say,
• 30:30normalized the challenges that supervisors
• 30:33have while addressing race and culture.
• 30:36So really overwhelmingly positive
• 30:37feedback that we were getting
• 30:40from a qualitative standpoint.
• 30:42So what did we learn from this
• 30:44specific pilot, really taking stock,
• 30:46the workshop attrition.
• 30:47This is a real world implementation.
• 30:49We had clinical leaders with
• 30:51robust demands for their time.
• 30:54There were also our second set of sessions
• 30:56also happened during the Omicron surge.
• 30:58And so we had significant provider
• 31:00shortages as well as COVID absences.
• 31:03And then the meeting cadence didn't actually
• 31:05reflect what we had originally intended.
• 31:07It was about 8 months in total as opposed
• 31:09to those six months that we had aimed for.
• 31:12We heard some feedback about the formatting.
• 31:14Participants wanted more time
• 31:15with the subject matter experts.
• 31:17And I would have never thought that
• 31:19folks would say we actually want
• 31:20more time because as you just heard,
• 31:22like people were having a hard
• 31:23time making it to those sessions.
• 31:24But people were like, we need more,
• 31:26we need more from the subject matter experts.
• 31:29There were those logistical barriers that
• 31:30we did have the sessions at a fixed time.
• 31:32So people did raise that.
• 31:34And then we also had some
• 31:36feedback around the content.
• 31:37So we found that supervisors actually
• 31:40wanted like supervision fundamentals.
• 31:42How do we become a supervisor
• 31:43and how do we move away from,
• 31:45I'm just going to do what
• 31:47my really wonderful,
• 31:47amazing supervisors did and try to
• 31:49avoid what my not so great supervisors
• 31:51did to how do I engage in an evidence
• 31:55based practice of supervision.
• 31:57And then Amber,
• 31:58is there any way we can curate
• 32:00those supplemental materials?
• 32:02And so we, we had an answer to that.
• 32:05So I'm going to talk now about some
• 32:07of the GROW 2.0 efforts and GROW
• 32:09initiatives based on that original pilot.
• 32:12So I'll talk about the funding,
• 32:13I'll talk about collaborative
• 32:14partnerships and some of the expansion.
• 32:16So we were and y'all this metaphor
• 32:18really stretches. So we were growing.
• 32:20We wanted to really think about the
• 32:22opportunities within the psychiatry
• 32:24residency because those four folks
• 32:27that had participated in our pilot
• 32:29from each of the clinical institutions
• 32:31were like, yeah, I think that
• 32:32there's a lot of yield here.
• 32:33And in fact, there's not a lot changes
• 32:35that you need to make to have this be
• 32:37readily applicable to the faculty who are
• 32:40supervising our psychiatry residents.
• 32:42So we had several meetings with the
• 32:44interim psychiatry leadership to
• 32:45align on priorities and to really
• 32:47think about the recruitment strategy.
• 32:49We talked a lot with clinical institution
• 32:51leadership at Yale Health, at the VA,
• 32:53Yale New Haven Hospital, CMHC.
• 32:55We were able to be invited to
• 32:58attend faculty meetings.
• 33:00We were able to collaborate with
• 33:01especially at Yelding Haven Hospital
• 33:03at the time faculty who would want
• 33:05to participate and try to identify
• 33:07potential opportunities for release time.
• 33:08We re invited the long term care clinic
• 33:10because as I said before there was a
• 33:12wait list that we wanted to free up
• 33:14and again we made this available to
• 33:16the psychology internship faculty.
• 33:18We also started to go outside
• 33:19the department again, right?
• 33:20So we had consultation from the APE,
• 33:23American Psychological Association CEO,
• 33:25the their Chief Diversity Officer and who
• 33:28is now the Chief Diversity Officer and
• 33:30Chief of Psychology in the public interest.
• 33:32And then we also had consultation
• 33:34with subject matter experts who
• 33:36had taught some of our workshops to
• 33:37really refine the content further.
• 33:39We also started to have a number of
• 33:42collaborative partnerships emerge.
• 33:43So our collaborative partnerships with
• 33:45the Teaching and Learning Centre continued,
• 33:47have really great conversations
• 33:50with Janet Heffler,
• 33:51with John and Candela about early outcomes
• 33:54and about refining our two point O design.
• 33:56We got in touch with the Gilder
• 33:58Lehrman Center for the Study of Slavery
• 34:00Resistance and Abolition Abolition,
• 34:01which I'll talk about in an upcoming
• 34:02slide because we realized history
• 34:04was a domain that was really missing
• 34:06and that came out of some of our
• 34:08conversations with the APAC suite.
• 34:09And then we really continue to
• 34:11engage with the office of DEI within
• 34:14the School of Medicine.
• 34:15We also had our first national partnership
• 34:18with the Northwestern University
• 34:20Counselling and Psychological Services,
• 34:22who sent eight of their clinicians
• 34:24to pilot our program in the hopes of
• 34:26expanding this offering to Northwestern.
• 34:27CAPS did a lot of pitching throughout
• 34:31the School of Medicine to a number
• 34:33of different stakeholder groups as
• 34:34well as in the university.
• 34:36We were able to be and and thank you
• 34:39to Doctor Crystal for I think the
• 34:41overwhelming support and engagement in
• 34:43the GROW program throughout its development.
• 34:46But at that time,
• 34:47we were able to get some funding
• 34:48from the Department of Psychiatry,
• 34:50Constantive Funding,
• 34:51funding from all of the sources
• 34:53that you see listed here.
• 34:54So we were getting funded
• 34:56within the department,
• 34:56but also within the university
• 34:58and within the School of Medicine.
• 35:02So what did you add, Amber?
• 35:03We added two modules.
• 35:04We added a module on history.
• 35:07If we can't as a department and
• 35:10as an institution and as a field,
• 35:12articulate the implications of racism
• 35:14and as they currently show up in a
• 35:16contemporary way in the clinical
• 35:17services that we provide and in the
• 35:19teaching and education that's happening,
• 35:21then are we really doing the work?
• 35:22So we added a module on history
• 35:24and we added supervision one O 1.
• 35:26We curated the supplements.
• 35:27So we heard, we heard the people
• 35:29and we heard the feedback.
• 35:30We actually created a curated journey.
• 35:32So as you went through,
• 35:33you didn't have to guess and
• 35:34you only had up to 10 items.
• 35:36And we really shortened the
• 35:38length of those items.
• 35:39We adjusted the small group.
• 35:40So how are we going to actually get
• 35:42people more contact with subject
• 35:44matter experts without increasing
• 35:45the amount of time that they
• 35:47have to spend in live workshops?
• 35:49To an unfeasible degree,
• 35:51we had the small group workshop
• 35:53or small groups become a required
• 35:56component and then we hired additional
• 35:58external facilitators to facilitate those.
• 36:01And then I developed a protocol,
• 36:03A workbook that really guided
• 36:04people step by step through.
• 36:06Here's what's going to happen
• 36:07in this session.
• 36:08Here's what are the role play efforts,
• 36:09and here are the learning outcomes.
• 36:11We also developed a much more
• 36:14robust evaluation plan with several
• 36:16different domains that I'll show
• 36:17you here in just a moment.
• 36:19So here's now the key content domains.
• 36:21What you'll just see here is
• 36:23those two additional domains that
• 36:25are slidden at the top.
• 36:26We continue to have our same format
• 36:28but now know that those small Co
• 36:30learning groups are facilitated
• 36:31and that they are now required
• 36:33and we really thought about the
• 36:34composition of those groups to make
• 36:36sure that the people who were in
• 36:39those groups were able to actually
• 36:40effectively learn from one another.
• 36:42We thought about rank of the participants,
• 36:44we thought about position,
• 36:45we thought about race,
• 36:47we thought about gender and really
• 36:49kind of so wanted to move beyond
• 36:52just are you all available to
• 36:54meet at the same time some samples
• 36:56of the learning objectives?
• 36:57I'm happy to send these slides around
• 36:59later so you don't have to memorize this,
• 37:01but I'm really thinking about how
• 37:02does history impact and what are
• 37:04some fundamentals of supervision
• 37:05that can be an evidence based model.
• 37:08To get that done,
• 37:10we came up with a much more
• 37:12robust measurement process.
• 37:14So we were measuring readiness for change.
• 37:17We were measuring personal
• 37:18self-awareness of race and culture.
• 37:20We were measuring whether or not
• 37:22people were engaging in multicultural
• 37:24knowledge and supervision as
• 37:26well as in clinical practice.
• 37:28We were asking people supervisors about their
• 37:31supervisory working alliance behaviors.
• 37:33We were asking also about impression
• 37:36management and socially desirable
• 37:37responding as well as demographics.
• 37:39So we really tried to survey much more
• 37:43broadly and much more tightly to some
• 37:46of our expected outcomes.
• 37:47Don't memorize this,
• 37:48but the main tweet here or the
• 37:50main I guess post if now if
• 37:52we're now thinking about eggs,
• 37:54is that overall learning
• 37:56satisfaction and overall usefulness.
• 37:59And that question of usefulness is like
• 38:01to what extent can is this session
• 38:04applicable to my professional practice
• 38:06continue to be incredibly high.
• 38:08And what you see here is that these
• 38:10numbers are actually much higher
• 38:11than the numbers in our pilot.
• 38:13And you'll also note that the attendance,
• 38:15we had about 50 folks registered
• 38:17for this pilot with a couple folks
• 38:19dropping off at the very beginning,
• 38:21but our attendance was very consistent.
• 38:23We had those sessions happen once per
• 38:24month and the small group sessions
• 38:26were happening also within the same
• 38:28month and they met twice per month.
• 38:30And our attendance rates for the
• 38:32sessions but also of the small
• 38:35group work were phenomenal.
• 38:37OK, so post program, just a couple things.
• 38:40How useful were the overall workshops
• 38:43from very to extremely useful?
• 38:4587% saying they're very useful.
• 38:47How useful were the small groups?
• 38:4985% saying very too extremely.
• 38:51How engaged were you in your small group?
• 38:54People were reporting that they were
• 38:56very engaged in their small groups.
• 38:58Amber,
• 38:58how useful were the supplemental materials?
• 39:00There's still some work to be done,
• 39:01but at least we're more than
• 39:02a coin toss here.
• 39:03We're at 65% in terms of usefulness
• 39:05of the supplemental materials,
• 39:06which is an improvement to
• 39:08what we saw in the beginning.
• 39:11Now we also asked people to
• 39:13again complete like what's your
• 39:15level of competence and to what
• 39:17extent are you engaging in these
• 39:19racially and culturally responsive
• 39:21behaviors within your supervision?
• 39:24We had 46 people complete that post survey,
• 39:2935 of those were participants
• 39:32and the remainder were controls.
• 39:34We over indexed a little bit on
• 39:36anonymity and so had a little
• 39:38bit of a difficult time matching
• 39:40participants to their pre and post data.
• 39:42Even though we had 30 participants
• 39:44in that the the program group that
• 39:47said they completed the pre survey,
• 39:49we were only able to ultimately
• 39:50match 17 people.
• 39:51But again,
• 39:52it was really important to us that
• 39:53we had anonymity and so I think we
• 39:55over indexed a little bit on that,
• 39:56but but for the 17 people that we were
• 39:58able to match, we saw significant.
• 40:01Improvement in the expected
• 40:02direction across each one of those
• 40:05previously assessed domains.
• 40:07And as you saw,
• 40:07we asked a lot more than that,
• 40:08but I just want to keep it consistent,
• 40:10significant improvement in those behaviors.
• 40:13We didn't see significant
• 40:14differences between people who went
• 40:16through the program and controls.
• 40:18But what we did find is that controls
• 40:21reported higher levels of socially
• 40:23desirable responding and lower levels
• 40:25of readiness for change than our
• 40:27grow participants who came forward.
• 40:29So more data on that to come and stand
• 40:32by as we continue to analyze that.
• 40:35We asked participants how competent
• 40:36they felt with the following
• 40:38things and what we found is that when
• 40:40we had program competence from somewhat
• 40:42competent to very competent, which we did,
• 40:44a four point liquid skill here,
• 40:4691% feeling somewhat to very competent,
• 40:49talking about race and racism,
• 40:51talking about social determinants of health,
• 40:53talking about power dynamics and supervision,
• 40:56thinking about the historical basis
• 40:59for disparities with trainees and being
• 41:01able to discuss that in supervision,
• 41:03being able to discuss instances of
• 41:05identity based harassment or discrimination
• 41:07and supervision increased to 94%.
• 41:10There's still some opportunities
• 41:11here for us in terms of supervisors
• 41:13being able to discuss racial identity
• 41:16development in the context of clinical
• 41:18service delivery and supervision.
• 41:20But we did see some improvement in terms
• 41:22of discussing power and privilege in
• 41:24clinical work with trainees as well.
• 41:29As a result of attending the GROW curriculum,
• 41:31I feel I have a better understanding of race
• 41:33and racism in my supervisory relationships.
• 41:36This was rated on a scale of one to five,
• 41:38with five being strongly agreed and what
• 41:40you see here is a four that people were
• 41:42feeling like they had a better understanding.
• 41:47I'll jog through this here,
• 41:48but the main summary is those
• 41:51first two columns are really
• 41:53asking about the impact of those
• 41:55facilitated small learning groups.
• 41:57People talked about the
• 41:59group cohesion and community.
• 42:00They talked about the topics
• 42:02being highly relevant.
• 42:04They talked about the utility of
• 42:06the group size and of the group members.
• 42:08Being able to identify with the different
• 42:10group members on different struggles and
• 42:12work through them meeting on a regular
• 42:14basis as being really key and critical.
• 42:16And then that these groups,
• 42:17the content and the process helped raise
• 42:20their awareness of racial identity.
• 42:22It encouraged them to engage in more
• 42:24anti racist work outside the context
• 42:27of their supervisory responsibilities.
• 42:28It increased compassion and honesty
• 42:30within themselves and within others.
• 42:33And I'm going to go through now some
• 42:35just really I think impactful quotes
• 42:37about the impact of the overall program.
• 42:39As we heard from the qualitative data,
• 42:41we had almost 100 different pieces
• 42:45of qualitative data that came out
• 42:47of that post program survey.
• 42:49We are wrapping up right now an
• 42:51additional study that's doing individual
• 42:53qualitative interviews for small group
• 42:56participants as well as individual
• 42:58interviews of our small group facilitators.
• 43:01So more data on that to come
• 43:02and and and stay tuned for it.
• 43:04So now I'm going to focus on the
• 43:06overall impact of the program.
• 43:07These are just a couple out of,
• 43:09again,
• 43:09almost 100 different comments
• 43:12that we got across.
• 43:13Each of those questions grow made
• 43:15me think about how to have a better
• 43:18standard of practice for inviting
• 43:20discussions of race and racism
• 43:21to be present in my supervision.
• 43:23I think previously I had relied
• 43:24on being a person of colour and
• 43:26that my people of colour trainees
• 43:28would feel comfortable,
• 43:30but was not thinking about how
• 43:32to encourage these conversations
• 43:33with my white trainees.
• 43:35I'm more confident that I would
• 43:37initiate a discussion or raise a
• 43:39concern in my clinical practice.
• 43:40I'm more confident about introducing
• 43:43inquiries about bias with patients of color.
• 43:45So you see here that it has the impact
• 43:48extends beyond what is happening within
• 43:51the context of clinical supervision
• 43:53also to the clinical practice of our
• 43:55clinical leaders and supervisors.
• 43:57This what I thought was really
• 43:59beautiful forgiveness and
• 44:00grace toward myself and others.
• 44:02This is an incredibly complicated
• 44:05topic or issue and topic.
• 44:07Oh,
• 44:07increased awareness.
• 44:08I'm just so much more aware and these are
• 44:11all different individuals by the way.
• 44:13I'm just so much more aware of the racism
• 44:15and structural racism all around me.
• 44:19I will actively address issues rather
• 44:21than leaving it to supervise these to
• 44:25bring these issues into the discussion.
• 44:28Grow impacted my supervision and
• 44:30clinical practices by renewing
• 44:31my commitment and enthusiasm for
• 44:33anti racism work in practices.
• 44:35I feel more confident,
• 44:37grounded and resilient.
• 44:38I feel more knowledgeable and
• 44:40skillful at conceptualizing and
• 44:42discussing intersectionality and
• 44:44structural analysis when working
• 44:46with clients or with supervisees.
• 44:49And then finally,
• 44:50I think the GROW program removed
• 44:52some of the fear of having
• 44:54discussions around race.
• 44:55The fear for this person was primarily of
• 44:58making white individuals uncomfortable,
• 45:00and they reported feeling less
• 45:01concerned about that.
• 45:02And I will say that that fearfulness,
• 45:05reduction of anxiety,
• 45:06that was also a theme that arose
• 45:07throughout many of these comments.
• 45:11So a couple things that we still need to
• 45:13solve for because there were still lingering
• 45:15concerns around grow two point O similar
• 45:17to what we heard in the pilot, clinicians
• 45:19and faculty still had limited time.
• 45:21There were people who were
• 45:22reaching out to me saying Amber,
• 45:23I want to participate, but you know,
• 45:25I can't get to those live sessions, I can't
• 45:27get to all of the small group sessions.
• 45:30And so this is certainly something
• 45:32that we need to continue to think
• 45:34about flexibility and scheduling,
• 45:36really thinking about to what
• 45:38extent can we combine asynchronous
• 45:39and synchronous components.
• 45:41But we also as a grow team
• 45:43started thinking a lot more about
• 45:45scalability and sustainability.
• 45:46Are we able to scale this
• 45:48because we can have, you know,
• 45:5050 participants in this program.
• 45:51But if we want to think about this
• 45:52as a national model or if we want to
• 45:54think about getting to the many, many,
• 45:55many faculty that we have involved in
• 45:57clinical services and involved in training,
• 45:59we need to think about how to make
• 46:01this bigger And it also costs money,
• 46:03right, to to do this.
• 46:04And so how can we do this
• 46:06in a sustainable way?
• 46:07We also have the issue of you know to
• 46:09mandate the training or not to mandate
• 46:10and we really had the position that
• 46:12mandating doesn't address some of these
• 46:13additional barriers that are laid out
• 46:15here in terms of limited time etcetera.
• 46:17And really we're still holding the position
• 46:19of wanting to be able to get the data
• 46:21to prove the effectiveness of the outcomes.
• 46:23And you know really thinking about some
• 46:25of the literature that talks about
• 46:26that there can be some potentially
• 46:28adverse consequences to to to mandating.
• 46:31So our response to that and this is
• 46:33a future direction has been a program
• 46:35that we're developing called Grow Seeds.
• 46:37So Grow Seeds is a an adaptation
• 46:40of our advanced core program,
• 46:42which is the Grow 2.0 program.
• 46:44It's designed to provide a practical
• 46:46point of entry for our supervisors.
• 46:48It includes 3 core content domains and
• 46:52the learning elements are asynchronous,
• 46:54so there's didactic content that's
• 46:56taken virtually asynchronously,
• 46:58the learning supplements and then
• 47:00self reflective practice.
• 47:01And we've also thought about a
• 47:03model of this that would include a
• 47:05small group cohort facilitation,
• 47:07so people could opt in to attending
• 47:09a small group that's facilitated
• 47:11by an external expert.
• 47:13But more to come on grow seeds.
• 47:15It's still in development and our hope
• 47:16is to launch that as soon as I get
• 47:19back from from having a baby next year.
• 47:21Our hope is to launch that at that time.
• 47:24So with the few minutes that
• 47:26I have remaining,
• 47:27I want to talk to you about where we
• 47:30are now with the GROW initiative.
• 47:31So you're going to see a video here
• 47:33that I'm going to narrate over.
• 47:35But our mission of the initiative
• 47:37is to Foster and sustain clinical
• 47:39and educational excellence.
• 47:41And here's how we're thinking
• 47:42about doing that.
• 47:43First is investing in skills.
• 47:44You already saw that with the
• 47:46programs that I just presented.
• 47:47We want to drive innovation by
• 47:49producing and sponsoring cutting
• 47:51edge research and scholarship and we
• 47:52want to give training opportunities,
• 47:54advanced trainees.
• 47:55Some of the accomplishments
• 47:57we've had three National Toxo,
• 47:59University of Michigan at the
• 48:02American Psychological Association.
• 48:04We have two training programs,
• 48:06which you just heard about our core
• 48:08training program and grow seeds.
• 48:09We have 3 sponsored research projects.
• 48:11We launched our website earlier this year
• 48:15and we have had ongoing collaborations.
• 48:17What you see here is a couple of
• 48:20pictures of us from the American
• 48:22Psychological Association.
• 48:23We did a symposium with Doctor
• 48:25Nadine Kaslow who is a nationally
• 48:27and internationally I would say
• 48:29renowned leader in supervision.
• 48:30You see here some of our colleagues
• 48:32that might be here in the space
• 48:34and there is a feature that's
• 48:35happening in the APA Monitor.
• 48:37We also wanted to really think about
• 48:39ongoing community and celebration.
• 48:41So you see here in May,
• 48:42we brought together our pilot group and
• 48:44our primary Grow Two Point O group to
• 48:47really celebrate their accomplishment.
• 48:48And this is a screenshot of the ARTF,
• 48:51which the ARTF celebration which Grow
• 48:54Co sponsored with a lot of branded
• 48:57materials and I Co sponsored that
• 48:59dancing line that you saw there.
• 49:01So I was able to get the people
• 49:02up on their feet.
• 49:03So we don't take credit
• 49:04for the ARTF celebration,
• 49:05but certainly for some of the
• 49:06dancing that was happening there.
• 49:08And then I'm also really proud to
• 49:10showcase some of the funded and sponsored
• 49:12work that has come out of the initiative.
• 49:14We had a fellow faculty research
• 49:17scholarship that was funded for
• 49:19the two folks that you see here.
• 49:20Doctor Cartagena,
• 49:21who actually has just joined the
• 49:23faculty who was a psychology
• 49:25doctoral intern within our program,
• 49:27and Doctor Jennifer Kilkas,
• 49:28they're doing a project called
• 49:29Switching the Code,
• 49:30Understanding Professionalism.
• 49:31Doctor Angela Haney was able to
• 49:34benefit from one of our professional
• 49:38development scholarships.
• 49:39And then we have current psychology
• 49:41doctoral interns doing their
• 49:42scholarly projects with us.
• 49:44We had postgraduate research associates
• 49:45working with us and we also we have
• 49:48two trainees from the University of
• 49:49Georgia who are supporting us in our
• 49:51Grow Two Point O evaluation initiative.
• 49:55So I want to wrap up here and give us
• 49:58a couple of minutes more for questions
• 50:02by saying thank you to the entire GROW team.
• 50:06And I'm going to ask if we can have
• 50:08the link to the website put into
• 50:10the chat so that you all can see.
• 50:12There are many,
• 50:13many,
• 50:13many people who I won't be able to name.
• 50:15And in fact,
• 50:16I don't trust myself to remember
• 50:18every single person and don't want
• 50:20to omit someone inadvertently.
• 50:22But we had workshop presenters,
• 50:24small group facilitators,
• 50:26we had conversations in passing.
• 50:29All of these things contributed to the
• 50:31work that you see here before you today.
• 50:33I do want to thank
• 50:35many of the folks across the School of
• 50:37Medicine and across the university who
• 50:39really partnered with us around this.
• 50:41From a funding standpoint.
• 50:42I want to thank all of our
• 50:45grow fellows and trainees.
• 50:47I want to name Latasha Neal,
• 50:49they were our original trainee
• 50:51who worked with us and and now
• 50:53many of you may know Latasha Neal
• 50:55from the Anti Racism Task Force.
• 50:57But a lot of those glamour shots
• 50:59that you saw from the Grow Workbook,
• 51:00they were really partnering
• 51:01with us around that work.
• 51:03A couple other key folks that I want to
• 51:05name John Crystal for ongoing support,
• 51:08funding support,
• 51:08but also really helping to link and
• 51:11network us with really key folks across
• 51:13the department but also across the school.
• 51:16And I also want to thank Frank Fortunati,
• 51:18who had significant contributions,
• 51:20lots of conversations with me,
• 51:22and then also supported us from
• 51:24a funding standpoint to make sure
• 51:26that some of my time was able
• 51:28to be dedicated to this work.
• 51:30Thank you also to all of our supporters,
• 51:32which includes you, you,
• 51:33for being here this morning,
• 51:35and many of you who came through
• 51:37the program and participated.
• 51:39This program belongs to us
• 51:41and it's built for,
• 51:43it's built by us and for us.
• 51:45So thank you all for being here and
• 51:47participating in the conversation.
• 51:48Thank you for all of our grow,
• 51:51our grow program participants,
• 51:53for your openness,
• 51:55your honesty,
• 51:56your willingness and also for a lot
• 51:58of the good work that you've done
• 52:00to continue these conversations
• 52:01within your own clinical institutions
• 52:02and beyond the department and
• 52:04beyond the work that you do here.
• 52:06So with that,
• 52:07I'm going to stop and see
• 52:09if there are any questions.
• 52:10I think I've left us a pretty good
• 52:12margin of time for questions.
• 52:14There is the link in the chat if
• 52:16you want to go in and take a look
• 52:18at some of what we've got going
• 52:19on and brewing there.
• 52:20There is also a contact page
• 52:22that is on the website.
• 52:24So if you are interested
• 52:25in reaching out to us,
• 52:26seeing what we're working on or
• 52:28you want to refer us to different
• 52:30groups that we're happy to do that.
• 52:31So with that, I'm going to stop talking.
• 52:34I'm going to say that I,
• 52:36Cindy and Becca are here to collectively
• 52:39field any questions or comments,
• 52:40and I'm going to now go over into the
• 52:44chat because I haven't looked there yet.