Yale Psychiatry Grand Rounds: September 17, 2021

Transcript

• 00:00Maybe I could make just a few
• 00:02comments before we get started
• 00:03with our grand rounds today.
• 00:07First, in terms of upcoming lectures
• 00:09in the Grand Rounds series next week,
• 00:12we're thrilled to have the
• 00:15Agajanian Lecture and our speaker,
• 00:17Brian Roth, is is doing magic
• 00:20with a X ray crystallography
• 00:22and computational neuroscience,
• 00:26and he's going to be talking
• 00:28about new insights into the
• 00:29action of psychedelic drugs,
• 00:30which is a topic that is generating
• 00:33a lot of interest these days.
• 00:37Uhm, in two weeks, a member of our faculty.
• 00:42Doctor Ani animal.
• 00:44I will be talking about
• 00:46refugee mental health,
• 00:48refugee health and that
• 00:49should be a really great talk.
• 00:51She's been doing wonderful work
• 00:53here in New Haven in in that area.
• 00:57One other thing to comment on is by
• 01:01now everybody should have received
• 01:03a notice that the President of
• 01:05the Yale New Haven Health System,
• 01:07Minor Bergstrom,
• 01:08announced that she's going to
• 01:10step down in 2022.
• 01:12Miss Bergstrom has been a longstanding
• 01:14supporter of the Department of Psychiatry,
• 01:17has always valued mental health as an
• 01:20important part of health care delivery,
• 01:23and we really appreciate all
• 01:25of her support over the years.
• 01:27And we're excited to welcome Chris O'Connor,
• 01:30who was the President of Saint Rayfield
• 01:33Hospital for a for a while before
• 01:36it was acquired by Yale New Haven
• 01:39Hospital as the new CEO of Yale,
• 01:41New Haven Hospital in 2022.
• 01:44Uhm?
• 01:45And with that I just went mentioned
• 01:48as that's in the.
• 01:49Note that Trisha just told me so.
• 01:52You probably already heard it,
• 01:53which is that there are no
• 01:55semis for today's grand rounds,
• 01:57but there will be for next weeks
• 02:00for for Doctor Roth grand Rounds.
• 02:03Uhm,
• 02:03today is a grand rounds presentation
• 02:06is a very special grand rounds
• 02:09presentation I had mentioned
• 02:12before that that that one of the
• 02:15most important tasks that we have
• 02:17in front of us as a Department of
• 02:20psychiatry as a as a group is to
• 02:24become a more anti racist community
• 02:27of community that's more supportive
• 02:30of diversity, has a greater.
• 02:34Equity and and is more inclusive
• 02:38and as many of you know to further
• 02:43that aim we created the department's
• 02:46Anti Racism task force that has over
• 02:4990 participants in it and has been
• 02:53working now since its inception.
• 02:55Uh a year ago.
• 02:57So this year one year anniversary seems
• 03:01like a good time to take stock on.
• 03:03And on what we've been doing
• 03:05and and what we've accomplished
• 03:07and what we hope to do and.
• 03:10And so we wanted to have
• 03:15a grand rounds to 22.
• 03:19Shared with all of that with with all
• 03:21of you and and the goal is to have
• 03:24this be very participatory we have.
• 03:30The Co chair of the task Force and
• 03:33Deputy Chair for DI in the department.
• 03:36Cindy Cruz to will be leading
• 03:38the presentation,
• 03:38but but we've tried to make
• 03:40make sure that there's going to
• 03:42be a time for discussion,
• 03:43so I really hope that this will be.
• 03:49A lively presentation and discussion,
• 03:52and with that Cindy I will.
• 03:53I will pass the baton to you
• 03:58and and you can take it. Great,
• 04:01thank you so much John and
• 04:03thanks everyone for being here.
• 04:05This is a really special and important
• 04:07grand rounds for me to be able to talk
• 04:10to you about the work of the anti racism
• 04:13task force or a RTF as we call it.
• 04:17Uhm, just about a year ago Doctor
• 04:20Crystal sent out a letter on behalf
• 04:23of the Executive Committee outlining
• 04:26the department's anti racism agenda
• 04:28which he can find that on the Internet.
• 04:31But a large part of that was
• 04:34the anti racism task force,
• 04:36in which you know he outlined basic
• 04:38structure and a timeline for that,
• 04:41and since then we've been working
• 04:43really hard and diligently to
• 04:46and meeting every week to really
• 04:48realize the the dream and the vision
• 04:51for the anti racism task force.
• 04:54So I realize that some people today
• 04:56will know a lot about the anti
• 04:59racism task force because you are.
• 05:01Active engaged number and participant
• 05:03every week and others of you may
• 05:06be very new to the department
• 05:08and really may not know very much
• 05:10about the anti racism task force.
• 05:12So I'm going to try to sort of hit it
• 05:15in the middle where we can talk about
• 05:17our sort of our background and how
• 05:19we arrived at the anti racism task
• 05:22force and a bit of our work but also
• 05:24to share a bit of who are membership,
• 05:26who we are,
• 05:27who's participating in the task
• 05:31force as well.
• 05:33This year will actually have
• 05:34four grand rounds.
• 05:35I'll give you the dates in a second,
• 05:36but grand rounds is one important
• 05:39way that we think that we should
• 05:42routinely keep our Community informed,
• 05:44and so we will have for this year.
• 05:47But then we also have our department
• 05:49newsletter each month one of the
• 05:51subcommittees of which we have
• 05:53six that comprise the task Force
• 05:55One of those subcommittees will
• 05:57provide a brief paragraph or two to
• 06:00update you on their work as well.
• 06:02And we've been doing Instagram live things.
• 06:06And so China also includes
• 06:08social media in here,
• 06:09so we realize that it's
• 06:11a lot to keep up with.
• 06:13And we hoped just to do a better
• 06:15job of keeping you informed.
• 06:17So I'm going to share my screen.
• 06:25OK, can you all see this?
• 06:27Yes, OK, great, thank you uhm.
• 06:31So our goal for today is to update
• 06:34you on the progress of the RTF,
• 06:37and as John said,
• 06:39really encouraged discussion.
• 06:40So we're hoping to leave a
• 06:41lot of time for any questions.
• 06:43Things that you're curious about
• 06:45feedback that you might have.
• 06:48I also mentioned that there are four
• 06:50grand rounds this academic year
• 06:52dedicated to the anti racism taskforce.
• 06:55So today September 17th there's just
• 06:58an overview and a progress report.
• 07:01On December 10th will give you a little
• 07:03bit more of the overview in progress,
• 07:05but will have two subcommittees,
• 07:06education and faculty development
• 07:08present to you briefly on their progress,
• 07:12and so are the essence of some of the
• 07:16conversations that they have been having.
• 07:19And then in February will have the clinical
• 07:21and the Staff Subcommittee present,
• 07:23and then in March will have the
• 07:27Community and research subcommittees.
• 07:29But Many thanks to Stephanie O'Malley
• 07:32and Trisha Doll for allowing us to
• 07:36have four grand rounds this year,
• 07:38and really to in our effort to
• 07:41keep the community updated.
• 07:44So this is basically our outline
• 07:46or agenda for today talk.
• 07:48A little bit about the background.
• 07:50What was the catalyst for developing
• 07:53the anti racism task force?
• 07:55What are we trying to accomplish?
• 07:57How do we accomplish it and what
• 08:00happened or accomplishments to date?
• 08:03So an important catalyst and factor
• 08:07to developing the anti racism task
• 08:10force of course is 400 plus year legacy
• 08:14of racism in the United States and
• 08:18importantly how that manifests here
• 08:20at our university and in the School
• 08:23of Medicine and in our department.
• 08:26And so, uhm, you know,
• 08:28it's it's just important to recognize
• 08:31the legacy right here locally.
• 08:34And so I think multiple groups in our
• 08:39department overtime have informed us
• 08:41and let us know really how these issues
• 08:45impact them right here in our department.
• 08:50And then, of course, UM, recent events.
• 08:52So UHM, 2020 was a very difficult
• 08:55year for on a number of dimensions in.
• 08:59Certainly the killing of black and
• 09:02brown and other people of color.
• 09:04UM, with significant last year.
• 09:06Of course it continues to be significant,
• 09:08but several cases came to the
• 09:11forefront in the media and really
• 09:14sparked important social action.
• 09:16And so that's just another catalyst
• 09:19for us here.
• 09:20In our department and then of
• 09:23course there was COVID and the
• 09:25racial ethnic disparities that we,
• 09:28over time,
• 09:29learned more about and and obviously
• 09:32impacted us as healthcare providers
• 09:35and folks who care about social
• 09:39and other types of inequities.
• 09:41And so we had lots of discussions
• 09:44in the department about COVID and
• 09:47racial ethnic disparities and.
• 09:50Inmortality and in.
• 09:54Cases of COVID.
• 09:58And then similarly, UM,
• 10:01you know nationally and internationally.
• 10:03Of course, that anti Asian hate
• 10:07and violence was at the forefront
• 10:09in the news and in the media.
• 10:12But we also took care to remember that
• 10:16our institution in our department
• 10:18is not immune from those sentiments.
• 10:21And so we had people who actually experienced
• 10:25violence and hate and discrimination.
• 10:29Right here in our department.
• 10:30And so it was very important to to recognize
• 10:35that and act on those experiences.
• 10:41Another important background factor,
• 10:43and this is just data from our department
• 10:47and this is from October of last year.
• 10:50So right as our steering
• 10:52committee started to meet,
• 10:53I asked for some data from our department
• 10:57and this is where we stood last year.
• 11:00We have made some progress but
• 11:01I would say the numbers haven't
• 11:03changed significantly in the year,
• 11:05but this will be sort of our
• 11:07baseline measure if you will and
• 11:09will look at these numbers overtime.
• 11:11But as you can see,
• 11:12this is for ladder track faculty
• 11:15and we have race and ethnicity
• 11:18of factor and of fact faculty.
• 11:21And then we have the rank.
• 11:23So assistant associate and full professor.
• 11:26And as you can see here,
• 11:28just at every level that the majority
• 11:33of our faculty are white or Caucasian
• 11:37and overall out of the 247 faculty.
• 11:4272% of them were white or Caucasian.
• 11:47And this is just for the research rank,
• 11:50so out of the 65 total members
• 11:54of the research rank,
• 11:5865% of them are white and you
• 12:00can see sort of the percentages
• 12:03here for this specific ranks.
• 12:08One thing that we looked at that
• 12:10I'm not sure that we had been
• 12:12good at looking at in the past
• 12:13is really to also look at staff.
• 12:16And as you can see here a very similar
• 12:20pattern emerges and so that 79% of
• 12:23the professional staff are white.
• 12:2672% of the technicians are white,
• 12:2867 of administered,
• 12:3067% of administrative support or white,
• 12:33and 90% of managers are white
• 12:36in our department.
• 12:38Come and then 51% of the
• 12:40postdoctoral associates are white
• 12:42and in a postdoctoral associate
• 12:44is considered an employee with
• 12:46salary and fringe and postdoctoral
• 12:49fellow is a trainee with a stipend.
• 12:52But still the majority are white.
• 12:57Uhm, and so our work and anti racism
• 13:02builds upon our prior progress.
• 13:05We know that we have Chinese both
• 13:08in our residency and our psychology
• 13:11training program who are very
• 13:13active and socially just social,
• 13:15justice minded and really work
• 13:18in communities to address social
• 13:20determinants of health and equity.
• 13:23And so we've had a couple of grand rounds.
• 13:26Where are.
• 13:27Some residents in our residency
• 13:30training program have been able to
• 13:34showcase the work that they're doing,
• 13:35but also to highlight where they
• 13:38see the challenges and where they
• 13:40see the problems and where they but
• 13:43they think that you know we need
• 13:45to do about that so we have had
• 13:48ground grand rounds dedicated to
• 13:50hearing about the work in community,
• 13:53but also grappling with these
• 13:56difficult issues as a community.
• 13:58We know that in molecular psychiatry
• 14:01that they have had ongoing discussions,
• 14:05and then we've also been engaged in more,
• 14:07which is the minority organization
• 14:10for retention and expansion,
• 14:11which is a School of Medicine.
• 14:14Actually university wide now initiative
• 14:18that focuses on the retention and
• 14:22recruitment of underrepresented
• 14:24groups or minorities in in medicine.
• 14:28And so we have some.
• 14:29Close linkages to more and being
• 14:32able to to Co sponsor a lot
• 14:36of activities with more.
• 14:38And then of course, you know overtime,
• 14:41UM,
• 14:42our department has engaged in various
• 14:46DEI initiatives and anti racism work,
• 14:50and so it's not a recent phenomenon.
• 14:53And these are some of the initiatives
• 14:55that have taken place and continue
• 14:58to take place within our department.
• 15:01So diversity champions as we call it
• 15:05folks dedicated to addressing DEI in R.
• 15:08Uhm department.
• 15:09We've had the Diversity Committee
• 15:12and department wide,
• 15:14but also in the psychology section.
• 15:17Greater diversity of trainees.
• 15:20Overtime.
• 15:21We continue to strive and work for
• 15:24increasing diversity of new faculty hires.
• 15:27And of course,
• 15:28there's a social justice curriculum
• 15:30in the psychiatry training program
• 15:33and a diversity concentration within
• 15:35the psychology training program.
• 15:40And folks have pointed out that there is
• 15:43a need for change in all of our missions.
• 15:46As you know, our department has a tripartite
• 15:50mission focusing on clinical care,
• 15:52education, and research,
• 15:55so really needing to think about
• 15:57change in all of our core missions.
• 16:01So what we heard was that
• 16:05people at all levels, faculty,
• 16:07staff and Chinese are concerned
• 16:09for themselves and their families.
• 16:11Given police violence,
• 16:13we've had town halls focused
• 16:16on specific incidents of police
• 16:19brutality and violence and.
• 16:22People have talked about,
• 16:23you know this is not something
• 16:25that's out there.
• 16:26This is something that's happened to
• 16:27me and to my family or I'm scared
• 16:29that it will happen to me and my
• 16:31family and the people that I love.
• 16:33And so we we hear those stories.
• 16:37Uhm, we know that we need to improve our
• 16:40collaboration with the surrounding community,
• 16:42including improving access to care and one
• 16:46challenges defining who or what community is.
• 16:49So of course,
• 16:50there's the surrounding New Haven community,
• 16:52but we also have several affiliated
• 16:56institutions with our department.
• 16:58So who are who should we be reaching out to?
• 17:00And what does that look like?
• 17:03Folks have talked to us about our department
• 17:06culture and their own experiences of
• 17:09repeated exposure to race this behavior,
• 17:12and I should say not just racist behavior,
• 17:14but that's what we're focusing on today.
• 17:16But folks have talked about their
• 17:19exposure from patients from their
• 17:22colleagues from supervisors,
• 17:24from attendings,
• 17:25and so we routinely hear about those stories.
• 17:29Folks are concerned that there is
• 17:32inadequate diversity within our.
• 17:33Department and as you saw,
• 17:35particularly at the senior Faculty
• 17:37and staff ranks,
• 17:39and so that matches the data and
• 17:42then people have equity concerns.
• 17:44And that's across the number
• 17:46of domains from the speakers,
• 17:48that images that we see, startup salary,
• 17:53leadership position,
• 17:54and committee membership.
• 17:57Uhm, and then again people.
• 18:01The core missions of our department,
• 18:04the culture of care and
• 18:06education and research,
• 18:07and how can we do a better
• 18:09job of addressing the eye.
• 18:11And in this case,
• 18:13particularly race and racism.
• 18:18So I'm going to present a couple of
• 18:20definitions that I initially presented to
• 18:23the steering committee almost a year ago.
• 18:26We are going to be revising these or
• 18:29really gathering other definitions
• 18:31and bringing them to the community.
• 18:35Just to have some consensus on sort
• 18:37of how we think as a community about
• 18:40racism and anti racism, but just as a
• 18:44sort of foundational piece for today,
• 18:46I'm just going to present some
• 18:48that really resonated with me.
• 18:50About a year ago.
• 18:53So racism is what happens when you
• 18:57back one groups racial bias with legal
• 19:00authority and institutional control
• 19:03when you have overwhelming homogeneity.
• 19:05At the tables where decisions are being
• 19:08made that affect peoples the lives
• 19:11of people who aren't at those tables.
• 19:14And so that's just something to think about.
• 19:16If I had a magic wand,
• 19:17I would just encourage everyone to
• 19:19say in the spaces where you are,
• 19:21who who's missing and how.
• 19:23Do we get them at this table and
• 19:27their voices represented?
• 19:29So anti racism is the active process
• 19:32of identifying and eliminating
• 19:34racism by changing systems,
• 19:36organizational structures,
• 19:37policies and practices and attitudes so that
• 19:41power is redistributed and shared equitably.
• 19:45And again,
• 19:46there are many different different
• 19:47definitions of anti racism.
• 19:49These are just some that resonated with
• 19:52me doing a lot of reading last year.
• 19:55And then one thing I really think is
• 19:58important is to move to racial justice,
• 20:01which is the systematic fair
• 20:03treatment of people of all races,
• 20:06resulting in equitable opportunities
• 20:08and outcomes for all.
• 20:11So what I like about this definition in
• 20:14the National Education Association is just
• 20:17that it talks about going beyond anti racism,
• 20:22so it's not just the absence of
• 20:25discrimination and inequities.
• 20:26But the presence of deliberate
• 20:28systems and supports to achieve
• 20:30and sustain racial equity through
• 20:33proactive and preventative measures.
• 20:35So what can we do to proactively to
• 20:38develop and cultivate the culture
• 20:41and the Community that we want?
• 20:44Not that we're just reacting to
• 20:47experiences of harmful behavior,
• 20:49and I think it's a challenge for
• 20:51all systems to do that,
• 20:52but I feel that that's where we should
• 20:54be going and how we should think about.
• 20:56Test.
• 20:58So what are we trying to accomplish?
• 21:03These are some of my favorite pictures from
• 21:06our department and what we're really trying
• 21:09to accomplish is that we support everyone,
• 21:13regardless of social identity or
• 21:15position or role in the department,
• 21:19but we support everyone to succeed
• 21:22and thrive,
• 21:23and we promote their well-being.
• 21:26The people that you see in these
• 21:29pictures represent faculty,
• 21:30staff and trainees who engage
• 21:32in all types of work,
• 21:34from basic research to global mental
• 21:37health initiatives and who are all
• 21:40from different cultural groups and
• 21:42backgrounds and the degree to which
• 21:45we can support everyone is is at a
• 21:48basic level where we are trying to go
• 21:52and what we're trying to accomplish.
• 21:55But more specifically,
• 21:56we're trying to improve our climate,
• 21:59our sense of belonging,
• 22:00and,
• 22:01as you may know,
• 22:02the university Presidents Oliveri
• 22:04actually has a committee on Diversity,
• 22:07Inclusion, and belonging,
• 22:08so they actually have a pretty
• 22:10long definition of belonging.
• 22:11But this was something that we
• 22:14thought thought about as well.
• 22:15We want to improve a cultivate
• 22:18and identity affirming environment
• 22:20so you can bring who you are to
• 22:23your work setting and environment.
• 22:25And that is affirmed.
• 22:27You don't have to cover and to mask
• 22:30up and a community of psychological
• 22:33and physical safety and acceptance,
• 22:36and decrease organizational
• 22:38tolerance for harassment.
• 22:40And in my read of the literature,
• 22:42this is one of the significant
• 22:46predictors of harmful behavior.
• 22:48Degree to which people perceive their work
• 22:52environment or setting as tolerating these.
• 22:55Behavior so uhm,
• 22:57if I had a magic wand,
• 22:59that's one thing that we would really
• 23:02work on is really proactively addressing
• 23:05harmful behavior and putting systems
• 23:08in place that can support people.
• 23:10We want to increase equity and opportunity
• 23:13and there are a number of things under that.
• 23:17But really, as you saw,
• 23:18the numbers of faculty and
• 23:20staff who are from racial,
• 23:23ethnic minority groups
• 23:24to really reach parity,
• 23:26it will take a while.
• 23:28But that that's really our goal and.
• 23:31And same for our training program.
• 23:36I know both of our training programs
• 23:38are very attuned to the eye
• 23:41issues and we want to support and
• 23:43continue that work and then improve
• 23:46relationships with our community.
• 23:48So again,
• 23:49defining community is essential
• 23:52task of our work.
• 23:54So my new favorite publication is
• 23:57a publication called The Water of
• 24:00Systems Change and it talks about
• 24:02we really need to think about system
• 24:05change and shifting the conditions
• 24:07that hold problems in place.
• 24:09And so this figure really talks
• 24:12about those six conditions of
• 24:15system change and the continuum
• 24:17of really what's explicit.
• 24:19What we can really see and
• 24:22address more easily.
• 24:23Are readily to really what's implicit
• 24:26that it's really hard for everyone
• 24:29to see and to experience, and so,
• 24:32UM, from the structural change,
• 24:35the explicit level, our policies,
• 24:39practices, and resource flows.
• 24:41Again,
• 24:42we can more easily readily see
• 24:44those and make some changes there.
• 24:47But what's a little bit more
• 24:49difficult and time consuming?
• 24:50Our relationships and connections?
• 24:52Which just means the quality of
• 24:55connections and communication that's
• 24:58occurring among actors in the system.
• 25:01So how do we relate to each other?
• 25:03Those and how can we think
• 25:07about power dynamics?
• 25:09Which is the next aspect of system change?
• 25:13So what's the distribution of
• 25:16decision making and authority?
• 25:19And that's both formal and
• 25:22informal decision making.
• 25:24And then probably the hardest
• 25:25according to this model.
• 25:27And I would agree the hardest thing
• 25:29to recognize and understand and
• 25:32change are those mental models or
• 25:35habits of thought which are just
• 25:38deeply held beliefs and assumptions,
• 25:40and the one that readily comes
• 25:42to mind is what does it mean to
• 25:44be excellent as a faculty member
• 25:46and who makes that decision.
• 25:48And they're, you know,
• 25:50some really ingrained mental
• 25:52models around
• 25:53that. But how do we sort of?
• 25:54Unpack that and create new models.
• 26:00So what's important about these
• 26:03three aspects of the conditions of
• 26:07system change is that they take
• 26:09a lot more time to understand,
• 26:13to recognize and to change.
• 26:16So real and equitable progress
• 26:18requires exceptional attention to the
• 26:21detailed and often mundane work of
• 26:23noticing what is invisible to many.
• 26:30And really, that's the work of
• 26:32our anti racism task force,
• 26:34but that's the work that we have
• 26:36all been engaged in as well.
• 26:38How do we think about relationships
• 26:40and power dynamics and those mental
• 26:43models that ultimately impact
• 26:45people's health and well being,
• 26:47but their ability to progress in our system?
• 26:51So what kind of structural
• 26:53changes are we talking about?
• 26:54And I won't go all over all of these,
• 26:56but these are the big buckets of
• 26:59things that we really need to
• 27:01address that there's some firmly
• 27:03ingrained patterns and mental
• 27:05models in addition to resources and
• 27:08things that we can more readily see.
• 27:10But recruitment and retention,
• 27:12training and education are policies
• 27:15and procedures.
• 27:17The amp process, of course,
• 27:19which is appointments and promotions process.
• 27:22How do we manage harmful behavior
• 27:24and so on to community,
• 27:27engage work and to research.
• 27:29So these are all of the areas
• 27:32that ultimately persistent change
• 27:34we we will need to address some
• 27:38aspect of these areas.
• 27:41So Doctor Crystal found found this and that.
• 27:44I thought, you know,
• 27:46we thought it was so appropriate.
• 27:48If you want to go fast, go alone.
• 27:50If you want to go far, go together.
• 27:53And that's really what we're trying to
• 27:56do is to have as many members of our
• 28:00department and community involved in
• 28:02this system change process as we can.
• 28:06So how do we accomplish this?
• 28:07Of course the anti racism task force is
• 28:10one of a number of initiatives within the
• 28:13department and my training and background.
• 28:16I've done a lot of work with community
• 28:19coalitions which brings different
• 28:21segments of communities and sectors
• 28:24of communities together to address
• 28:26mental health or substance use.
• 28:28And so I'm I'm used to coalitions and
• 28:31I'm trying to think about our task force.
• 28:35Come and apply some of the concepts and
• 28:39principles to our task force and so
• 28:42these are just some stages of coalition
• 28:44development from initial mobilization,
• 28:47which just means you're recruiting
• 28:50your critical mass of participants and
• 28:53you're engaging the key constituencies.
• 28:55In our case,
• 28:56within our department and Community
• 28:59establishing organizational structure.
• 29:02So this just.
• 29:05Defines the structure and the rules
• 29:08and the procedures and you really
• 29:10have to attend to tasks.
• 29:12Sort of what you get done but also to the
• 29:15maintenance those relationship functions,
• 29:18building trust and cohesion,
• 29:20and so you really at this stage will
• 29:23all stages have to to balance those
• 29:26two things tasks and maintenance
• 29:29capacity for action.
• 29:31It's really building knowledge and skills.
• 29:35To be able to carry out.
• 29:37Ultimately your action plan,
• 29:39and so we've done some training and
• 29:42lots of discussions and readings
• 29:44to really build our capacity for
• 29:47action and then planning for action.
• 29:50It's this is really prioritizing and
• 29:54clearly stating your goals and your mission.
• 29:56I mean,
• 29:57sort of we're right at this point for
• 29:59the work that that you're going to do.
• 30:02And then,
• 30:03of course implementation is carrying out.
• 30:05Uhm,
• 30:06your action plan and then
• 30:08institutionalization. That really means.
• 30:10What aspects of this are going
• 30:12to be sustained and where is it
• 30:15going to be sustained?
• 30:16Is that the Diversity Committee?
• 30:18Is that another standing committee?
• 30:20Is that within our affiliated institutions?
• 30:24Where will aspects of this work?
• 30:27Be sustained and institutionalized
• 30:29so that it doesn't just go away when
• 30:34the task force ceases to exist.
• 30:39So I'm also a program evaluator
• 30:41by training and so up this table
• 30:44just really shows four of those
• 30:47stages of coalition development.
• 30:49Some of the tasks that I mentioned
• 30:51associated with that stage,
• 30:52but also how we go about evaluating
• 30:55the functioning of our task force,
• 30:58and we've begun to do and will
• 31:00do more of this.
• 31:01So today I'm just going to talk a
• 31:03little bit about the the first one here
• 31:06in terms of initial mobilization extent.
• 31:08The level of participation and
• 31:11the representativeness of our
• 31:14participants of our community.
• 31:16So in terms of structure,
• 31:18this is what we look like.
• 31:20We have a steering community
• 31:22with Doctor Crystal and I
• 31:25Co. Chairing that we have a
• 31:27data and evaluation workgroup.
• 31:28We've heard routinely that accountability
• 31:31is important to our Community and so we
• 31:34do want to collect data and information
• 31:37to track how we're doing and certainly to
• 31:39know where we should make improvements.
• 31:42Nothing will be perfect,
• 31:44but if we have a routine.
• 31:47Feedback process and CQI process.
• 31:51That is how we will make it better,
• 31:53but we need data and information to do that.
• 31:57So we have six subcommittees, career,
• 31:59development, clinical community,
• 32:01education, research, and staff.
• 32:04And uhm, the steering committee
• 32:07is comprised of leadership of each
• 32:10institution and each missions.
• 32:12Really, the members of the Executive
• 32:15committee of our department.
• 32:16And then we have the subcommittee Co.
• 32:19Chairs.
• 32:19And then we have key additional leaders
• 32:23that faculty and trainees who are
• 32:26members of our steering committee,
• 32:29the Steering committee overseas,
• 32:30the activities of the subcommittees,
• 32:33and we meet weekly.
• 32:35Every Thursday at 4:00 o'clock
• 32:38since October of last year.
• 32:41These are all of the members of our
• 32:44steering committee and as you can see,
• 32:47I just want to highlight that we
• 32:50do have trainee involvement so the
• 32:52Psychiatry Residents Association or
• 32:54PRA the Co Presidents participate
• 32:57in the Steering committee.
• 32:59The same for our chief residence for
• 33:01diversity, equity and inclusion.
• 33:04We do not yet have psychology fellows
• 33:07represented on the steering committee,
• 33:09but they are participating in other ways.
• 33:12So two psychology fellows are actually
• 33:15doing their scholarly projects and
• 33:18focused one on evaluation and the other
• 33:20will be with the clinical subcommittee.
• 33:23So in terms of institutionalization,
• 33:26that that's a really important
• 33:28development that people are looking
• 33:30at this in a scholarly way,
• 33:32and it also helps contribute to the work.
• 33:35That we are doing.
• 33:39Uhm, this is from a meeting a couple
• 33:41of months ago where Darren Latimore,
• 33:43our medical schools Chief Diversity Officer,
• 33:47came and we provided an update.
• 33:51All of our subcommittees presented an
• 33:55update and and folks were just we invited
• 34:00him because folks were concerned or
• 34:02questioning the degree to which you know,
• 34:05Darren and the School of Medicine
• 34:07knew what we were doing this.
• 34:09Large undertaken in our commitment to
• 34:11the work and so we just decided that
• 34:15we would invite him and invite other
• 34:18members of the task force to participate.
• 34:20So what you see here are steering
• 34:22committee members, but also members of
• 34:26the subcommittees who participated.
• 34:31As I mentioned, we have six subcommittees,
• 34:33and the subcommittee leaders are
• 34:36departmental leadership, and their
• 34:38roles are germane to the subcommittee.
• 34:41These folks are actively engaged,
• 34:44and we gave careful,
• 34:47careful consideration to.
• 34:49Cultural background,
• 34:50so race and ethnicity.
• 34:52Professional diversity where you're
• 34:54situated or located within the
• 34:58department affiliated institutions.
• 35:01So there is careful thought in terms of
• 35:05selecting the Co chairs of each subcommittee.
• 35:08At the outset,
• 35:09we wanted the subcommittees to be manageable,
• 35:12so we wanted ten primary members,
• 35:15and we engage the Co chairs to
• 35:18help us think about defined roles.
• 35:21People that they felt that they needed
• 35:23so we could target a little bit of
• 35:25who would be on the subcommittees.
• 35:28But we also had an open nominations
• 35:31process for several weeks within
• 35:33the department where folks
• 35:35can nominate themselves,
• 35:37or they can nominate someone else.
• 35:38To actually participate on a subcommittee,
• 35:42including the steering committee,
• 35:44so this slide just describes
• 35:47that a little bit more.
• 35:49So I'm going to tell you a little
• 35:51bit about our subcommittees,
• 35:53and we have our pictures of
• 35:57folks there just so you know
• 35:59and recognize who who they are.
• 36:01But the clinical subcommittee is
• 36:03Co chaired by Deborah Bond and
• 36:06as many petrakos and and this,
• 36:09this sub community is really tasked
• 36:11with understanding the legacy of
• 36:13racism in the clinical workplace.
• 36:16Thinking about the diversity
• 36:17of the clinical workforce.
• 36:19Thinking about our practices,
• 36:21including access to care and outcomes and
• 36:25how they may or may not differ by race.
• 36:27And how we can support Chinese
• 36:30and faculty and staff who are
• 36:33exposed to racist racist behavior
• 36:35in these settings and contexts?
• 36:38And importantly,
• 36:39how do we support clinical programs
• 36:42as they introduce and think about
• 36:45change related to anti racism work?
• 36:48And we're doing that in just about
• 36:51probably all of the institutions,
• 36:54and some may be more intensively
• 36:56than others at the moment,
• 36:57but that's a critical feature of of the work.
• 37:02Their community subcommittee is
• 37:04Co chaired by Michael Sarniak
• 37:07and Michelle Silva.
• 37:08And really tasked with how racism has
• 37:13shaped our relationship with the community.
• 37:15And again,
• 37:15defining community that's part of
• 37:17the charge of that subcommittee.
• 37:20What are the boundaries or bounds
• 37:22of our work?
• 37:23And their objectives are to build
• 37:26more productive collaborations
• 37:28and improve Community access and
• 37:31engagement across our missions.
• 37:33And of course, to better serve our community,
• 37:36one of the things that they're,
• 37:37you know,
• 37:38wanting to do is just to take
• 37:39an inventory of work that people
• 37:41are already doing.
• 37:42Because as I mentioned before,
• 37:44from Chinese to faculty,
• 37:46the staff were all engaged at some
• 37:49level on in Community engaged work.
• 37:52And really,
• 37:53what does that mean and look
• 37:55like to serve our community?
• 37:58The education subcommittee chaired
• 38:01by Amber Childs and Kirsten Wilkins,
• 38:04again addressing the impact of
• 38:06racism on training,
• 38:08and how do we increase by POC
• 38:11representation among Chinese and faculty?
• 38:13So we have an emphasis on both,
• 38:15and we recognize that recruitment
• 38:18and retention of faculty has
• 38:21implications for our Chinese as well.
• 38:25And so, uh, they're engaged in or
• 38:28talking through anti racism training
• 38:31and the psychology training program is
• 38:34developing an incredible curriculum
• 38:37focused on racism in the clinical capacity.
• 38:42And then, of course,
• 38:44our psychiatry training program has
• 38:46the social justice and health equity
• 38:49curriculum an end to support for
• 38:52Chinese exposed to racist behavior.
• 38:55So some of these activities will cross
• 38:58subcommittees, and so we're hoping
• 39:01for that interface across groups.
• 39:04And then the Faculty Development
• 39:07Subcommittee.
• 39:07Sorry bout that, UM, chaired by me,
• 39:09Addie, and Sam Ball is really to
• 39:12promote the career development
• 39:14of folks who are underrepresented
• 39:17and medicine through mentorship,
• 39:19leadership, development,
• 39:20and for nomination of awards.
• 39:23So honorifics is another area that has
• 39:27been identified where there are inequities,
• 39:29so the degree to which folks can be
• 39:32nominated for awards and opportunities.
• 39:34It's it's.
• 39:35Really important.
• 39:36And they want to address the distinctive
• 39:39challenges of folks who are from
• 39:42underrepresented minority backgrounds.
• 39:44And I can say we're all really proud of this
• 39:46last one 'cause it has actually happened.
• 39:48Although I don't know if
• 39:50it's formally approved.
• 39:51But to add a section in the eye.
• 39:56In the A&P materials to add a section
• 39:59on DI and anti racism activities.
• 40:02So in our department we have two optional
• 40:06statements that people faculty can complete.
• 40:09One relates to DI slash anti racism
• 40:12and one taught speaks to the impact
• 40:16of COVID on their professional
• 40:18life and productivity.
• 40:20So we have something in place in our
• 40:23department and we've also contributed to.
• 40:25A similar effort in the School of Medicine,
• 40:29which actually the idea
• 40:31first started with Robert.
• 40:34Bob Robot many years ago and the Diversity
• 40:37Committee sort of picked that up,
• 40:38and then it sort of went to
• 40:40the anti racism task force.
• 40:42But in the CV Part 2 there's proposal
• 40:45to include the eye and anti racism
• 40:49activities and every single category
• 40:52that folks can can write about.
• 40:56And and then the research Subcommittee,
• 40:59Uhm Co,
• 41:00chaired by Cherelle Bellamy
• 41:02and Marina Picciotto,
• 41:04and it really addresses the impact
• 41:08of the legacy of racism in research.
• 41:12And what are some of the practices to
• 41:15recruit bipac research trainees and faculty?
• 41:18How do we engage bipac individuals
• 41:20as participants in research and what
• 41:23are people doing in our department
• 41:25related to health disparities,
• 41:27anti racism and what are the ways?
• 41:30Can we maximize research funding to
• 41:34to conduct research in these areas?
• 41:37And then we have the Staff Subcommittee
• 41:40Uhm Co chaired by Kyle Peterson
• 41:42and Karima Robinson,
• 41:43and and really to promote the
• 41:46professional development and mentoring,
• 41:48racial and ethnic minority staff to
• 41:51examine human resource practices.
• 41:55And again adjusting harmful
• 41:56behavior towards staff,
• 41:58improve communications and transparency
• 42:00around how decisions are made
• 42:02and recognize staff contributions
• 42:05and their accomplishments.
• 42:09So I just want to personally
• 42:11thank all of the subcommittee
• 42:13Co Chairs for an amazing job.
• 42:16Not only do they meet weekly
• 42:18for the steering committee,
• 42:19but most most also meet weekly for
• 42:23their steering committee meetings,
• 42:26and it's a heavy lift and a lot to ask.
• 42:28And I just, you know,
• 42:31really appreciate all of the
• 42:33hard work that has gone into
• 42:35developing this and and making
• 42:37it the best intervention that we.
• 42:39We possibly can.
• 42:40Uhm I wanna just announce that minutes
• 42:43are posted on the Internet so anyone
• 42:46can in our in our community can go
• 42:49in and look at the status and the
• 42:52progress of the Steering Committee
• 42:53as well as the subcommittees.
• 42:56And we want to be transparent about
• 42:59what's happening and so you're able to
• 43:01go in and to access those meeting minutes.
• 43:04And we're asking all of the
• 43:06subcommittees to collaborate
• 43:07with the data and evaluation.
• 43:09Worker again,
• 43:10accountability has come up a lot
• 43:12and people would like to know the
• 43:15progress that that we're making,
• 43:17and we can only provide that if we have
• 43:20the data and information to do that.
• 43:23So what I think Doctor Crystal
• 43:27for UM for you allowing for this
• 43:30data and evaluation workgroup.
• 43:32It's like just a critical piece
• 43:35of what what we have to do
• 43:37to measure our progress and.
• 43:39Just have a good CQI process to
• 43:43improve what it is that we do.
• 43:46So this is the data and evaluation
• 43:49work group what what we actually do,
• 43:51so it's me my.
• 43:54Colleague Joy Kauffman and Uhm,
• 43:57one of our psychology fellows
• 43:59who I'm so thankful is joining
• 44:01us in this work and she to Aurora
• 44:04and we assist the subcommittees
• 44:07with developing logic models.
• 44:09Basically thinking about your activities
• 44:11and what outcomes might stem from those.
• 44:14We will help them set up
• 44:16data collection systems,
• 44:18will help with developing reports
• 44:20to the steering committee and
• 44:22of course we want to make this.
• 44:24Group inclusive as well so we can add
• 44:26folks to to this work group overtime
• 44:28for people who may be interested,
• 44:31but again,
• 44:31a really critical and piece of the work.
• 44:35So this is our initial timeline.
• 44:37Uhm,
• 44:37month one was to create a diverse
• 44:41subcommittee comprised of an array of
• 44:43groups and then months two and four.
• 44:45We were supposed to have already
• 44:47developed practicable short term
• 44:49goals and then months five through
• 44:5317 was the initial inflammation
• 44:56implementation and read out.
• 44:58So this is not the timeline.
• 45:01Now we recognize that more
• 45:04work needed to be done.
• 45:07Uhm,
• 45:08to build that trust and collaboration and UM,
• 45:13having those difficult conversations
• 45:15alongside of you know the practical
• 45:18tasks that need to be done.
• 45:20But we realize,
• 45:22you know,
• 45:24developing a plan also is built
• 45:28on a foundation of trust and
• 45:31support and common under and
• 45:34shared understanding and so.
• 45:36Initially,
• 45:36I think we're supposed to go
• 45:39through April 2022 and we are likely
• 45:42thinking that that will be extended.
• 45:47Uh.
• 45:51So here's a timeline of activities
• 45:53I won't go through in detail,
• 45:55but as you can see initial mobilizations,
• 45:57so just getting the right people together,
• 46:00making the announcement that this was
• 46:03going to happen getting you know the the
• 46:06SUB Committee nominations process right,
• 46:09making sure that people knew that they
• 46:12could nominate themselves or someone else,
• 46:14and having the subcommittee Co
• 46:16chairs really review those carefully
• 46:19for diversity along a number.
• 46:21Of dimensions so that took a couple of months
• 46:25from September to probably about January.
• 46:29And then we really established out
• 46:32organizational structure over time
• 46:34and and we have had some training.
• 46:39We had the People's Institute for Survival
• 46:43and beyond come for a three day workshop on
• 46:47undoing racism for our steering committee.
• 46:50But we also invited other
• 46:53members of the subcommittees.
• 46:55So we are actively in the planning
• 46:58for action and really thinking
• 47:02about implementation coming up here.
• 47:06So what I want to do quickly is talk
• 47:08about the characteristics of our anti
• 47:11racism task force and the membership.
• 47:13So we have 95 total members.
• 47:16That's across the steering committee
• 47:18and the six subcommittees and
• 47:20the evaluation workgroup.
• 47:21And we administered a survey just to
• 47:25understand who's participating and so 86
• 47:27of those 95 people completed the survey.
• 47:31So 91% response rate, which is great.
• 47:34We harass people a lot for a while, but.
• 47:36We did get a great response
• 47:38rate and as you can see,
• 47:40UM in terms of race,
• 47:42a 38.2% of our membership,
• 47:47identified as a member of our Racial
• 47:51Group Racial Minority group up,
• 47:55and then 41% are Caucasian or white
• 47:59and then 7% were Latinx or Hispanic.
• 48:04It's 58% females,
• 48:076% identified as having a disability,
• 48:127% identified as being a
• 48:15sexual gender minority,
• 48:1831% were first generation college student
• 48:20and again this is across the board.
• 48:23So faculty,
• 48:24staff and trainees and what that
• 48:27means is they did not have a
• 48:30parent that graduated from college.
• 48:3326% said that they came from a
• 48:36disadvantaged background and we
• 48:38asked about lived experience and
• 48:4142% said that they were from racial
• 48:45ethnic minority background.
• 48:4824 said that they experienced disability.
• 48:525% said that they had experience
• 48:54with substance use or challenge
• 48:57and then 7% had other challenges
• 49:00that they or life experiences.
• 49:03That they told us about.
• 49:05Then we asked people if they hadn't
• 49:08identified with identity based prejudice
• 49:10or discrimination so that people
• 49:12experience this themselves and we
• 49:14just ask about a number of different
• 49:17dimensions from ancestry or natural
• 49:19national origin to income level to raise.
• 49:23And you can see some of
• 49:25the percentages there.
• 49:26So just because we're in an academic.
• 49:30Community and you know,
• 49:32or in professional environment,
• 49:35people still bring their experiences
• 49:37and their backgrounds to this work.
• 49:40And it's just important to recognize the
• 49:44diversity within our task force as well.
• 49:47And people have some real lived
• 49:50experience regardless of your position
• 49:53in the task force or our department.
• 49:58Uhm,
• 49:58we asked people if they were
• 50:01in recovering from
• 50:02some type of experience and we asked
• 50:06everything from mental health to medical
• 50:09physical conditions to psychological trauma.
• 50:11And again you can see the percentages there.
• 50:14And then 50% had experience as a
• 50:18graduate student or a resident.
• 50:22So this is just representation
• 50:24by department role.
• 50:26UM, so I won't go over this in detail,
• 50:29but again, just tracking how many faculty,
• 50:31staff and Chinese are involved and
• 50:33we want to make sure that we have
• 50:36representation from all of those
• 50:37groups across all of our committees.
• 50:40And this is just average attendance.
• 50:42Overtime again,
• 50:43for each of the sub communities.
• 50:44The number of meetings that
• 50:46they've had when they have met and
• 50:49then just the average attendance
• 50:51rate here in this last column.
• 50:53So we can see.
• 50:56What people's participation looks like.
• 51:01One question that I've gotten is the
• 51:03difference between the anti racism
• 51:05task force and the Diversity Committee,
• 51:07and there's definitely overlap.
• 51:10Both communities address
• 51:11issues of race and ethnicity.
• 51:14The Diversity Committee is just
• 51:16broader addresses, a number of
• 51:19different dimensions of diversity,
• 51:20but really at the foundation is addressing
• 51:24these system change processes and
• 51:26underlying issues that we want to address.
• 51:31So, accomplishments,
• 51:31and here's where I'm going to
• 51:33end in time for discussion.
• 51:34So, and this is a long list,
• 51:37but there's probably many,
• 51:39many others so others can chime in.
• 51:42So we had some important promotions within
• 51:45our department for me and for Doctor Knee,
• 51:49Addie Ann,
• 51:50and we had Steve Gentle and and
• 51:55administrative staff calculate for us
• 51:58approximately how much we're actually
• 52:00investing in terms of dollars.
• 52:02Into our anti racism and I work and it's
• 52:09approximately 600 and $83,000 per year.
• 52:12So that's faculty time,
• 52:15staff time and trainees,
• 52:16which I think is speaks.
• 52:20A lot and is important.
• 52:22We've changed grand round process ease
• 52:25in terms of how invitations are made up.
• 52:29Talking with speakers and
• 52:31collecting demographic background
• 52:33information from our speakers.
• 52:35We've had a lot more
• 52:37overtime past seven years,
• 52:39probably just a significant
• 52:41increase in the number of.
• 52:43Uhm, grand rounds that focus on DI issues,
• 52:46but also speakers from diverse backgrounds.
• 52:51We've changed the composition
• 52:53of the department committees to
• 52:55include diverse representation.
• 52:57As I mentioned,
• 52:58these supplemental optional DI COVID-19
• 53:01impact statements in the AMP process.
• 53:05We have diverse candidates
• 53:06under consideration for the
• 53:08residency Training Director.
• 53:10We have projects in apps to support staff.
• 53:14We've had numerous town halls
• 53:17in response to community level,
• 53:19tragedies,
• 53:20and events.
• 53:21And we've had statements as
• 53:24well written statements that,
• 53:26in response to racism but also
• 53:29other Community level events,
• 53:31we are planning to provide support
• 53:34to black trainees and we are
• 53:37doing it for black clinicians.
• 53:39We have the getting racism out of our
• 53:42work curriculum spearheaded by Amber Childs,
• 53:45Becca Miller and by me developed
• 53:49to really think about race and
• 53:52racism in the clinical context
• 53:54and specifically supervision.
• 53:56And that pilot will start this month.
• 53:59We addressed public images and shout
• 54:01out to my Oprah Boo and the art and
• 54:04Library Committee of the Diversity
• 54:06Committee for really spearheading
• 54:08thinking about the images that we see.
• 54:12We consult to clinical sites and we
• 54:15have the eye focused coaching that
• 54:18we're going to hopefully will allow.
• 54:22Up in terms of the anti racism
• 54:24task force we have formed it.
• 54:26We are meeting regularly and I feel
• 54:28that we are mostly representative
• 54:30of the department and overall an
• 54:33active and engaged membership.
• 54:35As I mentioned,
• 54:36we've been participating in undoing racism,
• 54:38workshops,
• 54:38linkages and connections within
• 54:41the School of Medicine.
• 54:43A lot of work of building trusts and
• 54:46engaging our department community
• 54:49in a number of different ways.
• 54:52So in summary,
• 54:53our focus on anti racism may be
• 54:55the most important department
• 54:56initiative at this time and we
• 54:59continue to hope for broad engagement
• 55:01of the department and
• 55:03we do aspire for transparency.
• 55:05And we in Ames processes and
• 55:08outcomes and I really have to give
• 55:11a special thank you to Jan's alone.
• 55:14Helping Donohoe and Jennifer
• 55:17La Hurt let Tasha Neal.
• 55:20These are folks who attend meetings and take
• 55:23meeting minutes for every single meeting.
• 55:25It's a lot of work and so I really
• 55:28we all appreciate your work.
• 55:30Melissa Funaro,
• 55:31who is our librarian dedicated to
• 55:34our department who's been so helpful
• 55:37to us and lip reviews on a number
• 55:40of different areas and fronts.
• 55:41Chris Gardner and Jordan Sisson.
• 55:44For all the communications support
• 55:46it's it's a lot that we ask of them,
• 55:48so really appreciate that.
• 55:50Our subcommittee Co chairs
• 55:51or they mentioned before,
• 55:53who are all just really engaged and
• 55:56wonderful to work with and great vision.
• 56:00And of course,
• 56:01all of the committee members sub comedian,
• 56:03steering committee members and a
• 56:05special thank you to Luming Li and who
• 56:09Co chaired the clinical Co chaired the
• 56:12clinical subcommittee for few months.
• 56:15Before maternity leave,
• 56:16but then also she transitioned to
• 56:19another position in Houston but really
• 56:22want to thank her and then I Anna
• 56:25Jordan who will be transitioning to NYU.
• 56:29I believe starting next month,
• 56:31which obviously will be a
• 56:33big loss to our department,
• 56:36but especially the Steering
• 56:38Committee for all of her engagement,
• 56:41active insights and discussion so.
• 56:45That is all that I have.
• 56:47I know I talked a lot but wanted to be
• 56:51sure to give give it justice to all
• 56:53of the work that we have been doing.
• 56:55So we are going to open it up
• 56:57for any discussion and comments.
• 57:29Feedback, but we could do more of less of.
• 57:33Reactions to what you heard, what you saw.
• 57:37Sandy, thank you so much for such a
• 57:40wonderful summary info. Your work.
• 57:42Uhm, we always enjoyed working with you.
• 57:46You mentioned the training that
• 57:49the committees had and I don't
• 57:53think the audience here. No.
• 57:55What is involved in the undoing racism.
• 57:59Workshops, so wondered if you can give it
• 58:02just a few sentences of what is it about.
• 58:06I think it will be important
• 58:08for the audience to hear.
• 58:10I'm gonna see is Kyle here.
• 58:14No. So, undoing racism is typically
• 58:21three days, at least two and a half.
• 58:23They have other version versions
• 58:25of this that are shorter, but.
• 58:27They recommended one is three days
• 58:31a week where the People's Institute
• 58:35for Survival and beyond so they are
• 58:38community organizers based in New Orleans,
• 58:41but just a longstanding history,
• 58:43I believe from the 1960s to really help
• 58:48communities think about organizing.
• 58:50And they really, I think,
• 58:51focus on the systems aspect.
• 58:54UM, so taking it out of the personal
• 58:57or interpersonal realm, but really,
• 58:59thinking about systems again,
• 59:02what are the systems factors that hold
• 59:06these problems that we might see in place?
• 59:10They do focus on.
• 59:13Racism, but uhm,
• 59:15really make sure to say that it really
• 59:19applies to a lot of other dimensions
• 59:22of diversity and social identities,
• 59:24so I think it's ultimately really about
• 59:28understanding the historical legacy of race.
• 59:32Race is a social construct,
• 59:35but also how we think about
• 59:39systems and systems change.
• 59:42So if anyone is more expert.
• 59:43Send me please chime in,
• 59:45but that's my experience of for them.
• 59:53Kyle, there you are. Yep, I'm here.
• 59:57I'm sorry to put you on the spot,
• 59:58but you are a trainer so I figure
• 01:00:00we should hear from from the expert.
• 01:00:03Yeah yeah, I think you did a great job,
• 01:00:05Cindy. The thing that I would emphasize the
• 01:00:07the about the People's Institute is that
• 01:00:09all the people who are trainers are also
• 01:00:12organizers and that is deeply embedded in
• 01:00:15the philosophy of the People's Institute.
• 01:00:17That racism is something that was
• 01:00:20organized into existence and we will need
• 01:00:23to organize to undo or dismantle racism.
• 01:00:25So it's an important part of.
• 01:00:28From what they do and practice,
• 01:00:33and we're organized locally too.
• 01:00:34So here in New Haven,
• 01:00:35there's something called the Elm City
• 01:00:38undoing racism organizing collective.
• 01:00:40We offer workshops and support
• 01:00:42and training throughout the year.
• 01:00:44In fact, there's a workshop
• 01:00:46going on virtually right now,
• 01:00:47so there are other ways to plug into
• 01:00:50this work outside of the department,
• 01:00:52and I think that's also really
• 01:00:54important that as a.
• 01:00:57One of the founders of the People's
• 01:01:00Institute talks about that this
• 01:01:01work is an inside outside job.
• 01:01:03So when you're working in institutions,
• 01:01:05it's also important to connect outside
• 01:01:07and with the communities where we're
• 01:01:10located and where we're serving up.
• 01:01:12That perspective is very important at work,
• 01:01:14and those relationships are
• 01:01:16really important as well.
• 01:01:23Thanks Kyle. Hi Cindy,
• 01:01:26it's can you hear me Robin?
• 01:01:30Thank you so much, Cindy.
• 01:01:31I think probably you're not hearing
• 01:01:33from a lot of people because they
• 01:01:35feel overwhelmed by what you've done.
• 01:01:38I mean, I know I have you and I've
• 01:01:40been in the department about the
• 01:01:42same amount of time and seeing what
• 01:01:44you've been able to accomplish,
• 01:01:46because every few years there would
• 01:01:47be a new initiative we need to do
• 01:01:49something about diversity and equity.
• 01:01:51We need to do something and to really
• 01:01:53see this come together over the
• 01:01:55past little over a year and a half.
• 01:01:56I just I'm so appreciative that
• 01:01:58we have you in this.
• 01:02:00Position and your leadership on this.
• 01:02:02It's it's quite incredible.
• 01:02:05I just had those overall thoughts
• 01:02:07and then you know there's so many
• 01:02:10specific things I could highlight,
• 01:02:12so I thought I would just pick one of them,
• 01:02:14which is the focus not just
• 01:02:17on the tenured faculty,
• 01:02:19but the focus also on our research
• 01:02:21faculty and our staff are trainees.
• 01:02:24I just you know that again,
• 01:02:25is trying to bring the invisible more
• 01:02:28visible that we all work together in
• 01:02:31this system and we need to be making it,
• 01:02:34you know, a safe place.
• 01:02:36For everybody in everybody to have
• 01:02:38opportunities to be promoted,
• 01:02:40to succeed,
• 01:02:41to have an equal opportunity at the table.
• 01:02:44So thank you that that's really
• 01:02:46just one small thing that you've
• 01:02:48presented that I thought I would just,
• 01:02:50you know, lift up.
• 01:02:51But thank you for all of your work.
• 01:02:55Thanks Robin. It's good to see you.
• 01:02:59Hey Cindy, it's easy a hum.
• 01:03:02Yeah, first of all,
• 01:03:04again thank you come you offer allowing
• 01:03:06sort of resident perspectives to be,
• 01:03:09you know, part of the steering committee.
• 01:03:10The table. One thing that I know is of
• 01:03:14interest is we are impressed by the budget.
• 01:03:17And wanted you to speak a little bit
• 01:03:20about how that budget is currently
• 01:03:22being distributed and ways in which we
• 01:03:24imagine it either growing or how the
• 01:03:26funds are going to be spent in the future
• 01:03:28as committees come up with different
• 01:03:30initiatives just laying the land out
• 01:03:31of that a little bit more for us.
• 01:03:35John, can I put you on the spot? Sure,
• 01:03:38it's not putting me on the spot.
• 01:03:40UM, so, so Asia.
• 01:03:43A lot of that budget are the salaries
• 01:03:47are they are the equivalent, UM?
• 01:03:51Amount of salary for the people
• 01:03:54who are diverting time away from
• 01:03:57a job in order to to support.
• 01:04:00The work of the task force,
• 01:04:03uhm, and one of the things that.
• 01:04:07Uhm, so let me just say that there
• 01:04:09are funds from the department that are
• 01:04:13supporting this through supporting.
• 01:04:17Cindy and some staff support and.
• 01:04:23Support from my office for for Halpin's
• 01:04:28work on on it and and other people but.
• 01:04:31But one of the things that that's
• 01:04:34been really great to see is how all
• 01:04:37of our collaborating institutes,
• 01:04:39Yale New Haven Hospital CMHC in the VA,
• 01:04:42have been good about freeing up
• 01:04:44people's time in order to support their,
• 01:04:47to allow them to work on the task force.
• 01:04:50And it's not only the faculty
• 01:04:52and the trainees where you might
• 01:04:53expect there be more flexibility,
• 01:04:55but also for the Staff Subcommittee as well,
• 01:04:58which which has been really great to see.
• 01:05:01I, I think one of the questions.
• 01:05:03That's implicit in what you've asked is.
• 01:05:06What what do we need going forward?
• 01:05:09What? What happens if some of the,
• 01:05:12uh, some of the objectives that we
• 01:05:15set require actual layout of cache?
• 01:05:20I think we're just going to have to cross
• 01:05:22that bridge when when we come to it.
• 01:05:24But I'm not afraid to invest in
• 01:05:27the in the work of the task force.
• 01:05:30I think we reap.
• 01:05:32Big dividends on the investment,
• 01:05:34so I'm happy to provide what support we can.
• 01:05:42Thank you.
• 01:05:49There's something in the chat about
• 01:05:51the diversity chiefs not being
• 01:05:53compensated for their work and job roles.
• 01:05:56Can I speak to this?
• 01:05:58I probably cannot do it justice,
• 01:06:00but there may be someone else who can.
• 01:06:03I know. Richard,
• 01:06:05if you can speak to that, come.
• 01:06:10Yeah, uhm Cindy, but I can't because
• 01:06:13I don't really have the background to
• 01:06:15the development of those positions.
• 01:06:18I do know that there are not funded.
• 01:06:24I don't.
• 01:06:26To. So I mean I I would just add
• 01:06:30to what what, what Richard said.
• 01:06:33Which was that?
• 01:06:34That the the participation in the task force.
• 01:06:39Uhm, I think is one of the ways that.
• 01:06:44That the chief residents for diversity
• 01:06:47can fulfill their roles as chief
• 01:06:49residents for diversity, which is providing.
• 01:06:52Input to the task force from
• 01:06:55their perspectives in that role.
• 01:06:58Generally speaking.
• 01:07:00People are are not compensated for
• 01:07:03their participation in the task force.
• 01:07:06There are few rules where
• 01:07:07we are compensating people,
• 01:07:09but mostly for people who are.
• 01:07:11Uhm?
• 01:07:12Are not already part of the
• 01:07:16department and are contributing
• 01:07:17their time to the task force.
• 01:07:22I think maybe Andy is referring
• 01:07:24to the program Wide Chiefs.
• 01:07:26I don't know this to be the case,
• 01:07:27but maybe they are compensated.
• 01:07:30I really don't know how that works,
• 01:07:32but I don't know if that's
• 01:07:33what you're referring to.
• 01:07:35Are the program white chiefs compensated
• 01:07:37to participate on their task force?
• 01:07:40No. Yeah, no, I don't.
• 01:07:42I don't, I don't. I don't think so.
• 01:07:59Something in the chat about addressing
• 01:08:02ongoing concerns about current
• 01:08:04racism in one meeting last year,
• 01:08:06there was a discussion of
• 01:08:08differential use of restraints.
• 01:08:10By race and ethnicity on one unit,
• 01:08:12including stats, I'm curious with the
• 01:08:14emphasis on Antiracism out department.
• 01:08:17How has this active racism in
• 01:08:20our department been addressed?
• 01:08:22Is there anyone from Yale New Haven
• 01:08:24Hospital who wants to speak on this
• 01:08:26or any other of the institutions
• 01:08:28that are addressing this?
• 01:08:29I know there's a lot of work
• 01:08:32happening so I may not be the
• 01:08:34best person to give it justice,
• 01:08:36so there's anyone from the institutions.
• 01:08:39I want to speak to this.
• 01:08:43Brett, perhaps I can speak to it if if
• 01:08:46if there isn't someone directly involved
• 01:08:48with it on on the on the green rounds.
• 01:08:51So first we had a wonderful presentation.
• 01:08:56Uh, I'm I'm, I'm I'm, I apologize for
• 01:09:00not recalling who presented it may.
• 01:09:03May have been Tyrell,
• 01:09:05but I'm not entirely sure.
• 01:09:07Where the data were analyzed and the.
• 01:09:11The results regarding restraints
• 01:09:13turned out to be quite complicated
• 01:09:16and suggested that there were deeper
• 01:09:19issues than than the surface issue,
• 01:09:22which in which you're addressing.
• 01:09:25So this was an analysis of restraints.
• 01:09:29The straight use, and it was there
• 01:09:32was a higher rate of restraining.
• 01:09:36Bipac individuals than Caucasians and.
• 01:09:43When the UM, when the group analyzed
• 01:09:47their data more in greater depth,
• 01:09:51what they found was was very interesting,
• 01:09:56which was that the rate of assaults
• 01:10:00of staff and other patients.
• 01:10:03Bye bye Park patients was higher
• 01:10:06than the rate of assault of staff.
• 01:10:10And and other patients by Caucasian patients.
• 01:10:16And if one adjusted the analysis.
• 01:10:20For the rate of assault.
• 01:10:23Then there was no differential
• 01:10:25use of restraints.
• 01:10:27For bipac patients than
• 01:10:29there was for white patients.
• 01:10:32So that careful analysis.
• 01:10:37Uhm,
• 01:10:38revealed that the issues about
• 01:10:41use of restraints.
• 01:10:44Were more complicated than simply
• 01:10:47unit policy around restraint use.
• 01:10:50But rather to ask the deeper and
• 01:10:53more complicated question about
• 01:10:55factors driving the increased
• 01:10:59rate of assaults on units,
• 01:11:02whether there were way,
• 01:11:03whether there are ways that the units
• 01:11:06could engage patients more effectively,
• 01:11:08or whether the BIPAC patients are
• 01:11:11coming in with greater levels of of
• 01:11:15morbidity or or other risk factors for.
• 01:11:20For violence that that could be appreciated,
• 01:11:23and and and programs directed at those,
• 01:11:29so I think the analysis first,
• 01:11:31I think the analysis is very
• 01:11:33important and I really appreciate.
• 01:11:35The units collaborating in in that analysis.
• 01:11:40And they raise.
• 01:11:42They raise really important questions about.
• 01:11:47About the life of of patients on our units.
• 01:11:55And I do know, UM, just ongoing work
• 01:11:58with some of the units up there is a
• 01:12:03lot that is happening from ongoing
• 01:12:05feedback from residents and interns to
• 01:12:09thinking about treatment and care models.
• 01:12:13Thinking about Chamah informed care,
• 01:12:15thinking about additional
• 01:12:17resources for staff.
• 01:12:19For especially for those units that are.
• 01:12:23Significantly understaffed and attending
• 01:12:27to education and training and UM,
• 01:12:32hate speech protocols.
• 01:12:34UM, consistent protocols around debriefing
• 01:12:38incidents that happen using those as
• 01:12:41learning opportunities and moments.
• 01:12:44So there is a lot happening at each
• 01:12:46of the institutions related to this,
• 01:12:49so it's an active ongoing work
• 01:12:52at each of the institutions.
• 01:12:57I like doctor crystal. I'm sonyma second
• 01:13:01year resident and I kind
• 01:13:03of just had a question,
• 01:13:05maybe comment so it seems like what
• 01:13:08you were saying just now is that.
• 01:13:10Bipac patients are in restraints more
• 01:13:13because they're the ones who are more
• 01:13:15violent towards staff or as I feel like.
• 01:13:19Maybe that's not been my experience,
• 01:13:21at least when I was on LV2 and sometimes
• 01:13:23I feel like restraints were used,
• 01:13:25not judicial judiciously, and come a lot
• 01:13:29of times it was.
• 01:13:31Just it I I don't think it was
• 01:13:33because the patients were more
• 01:13:35assaultive and that's why I'm
• 01:13:36sure maybe that's you know,
• 01:13:38a small percentage, or maybe even
• 01:13:39a medium percentage of the case.
• 01:13:41But I don't think it was fair
• 01:13:43to just reduce that.
• 01:13:45To to their behavior or
• 01:13:47something like that? Yeah,
• 01:13:49so Sonya, I appreciate.
• 01:13:51I appreciate your comment and and and
• 01:13:54so I would say that the that one of
• 01:13:58the challenges of of data is that it
• 01:14:02describes the property of a group of
• 01:14:06incidents over an extended period of
• 01:14:08time and may not speak to specific
• 01:14:12incidents about the use of restraints so.
• 01:14:15It could, it could be the case
• 01:14:19that that there would be incidents
• 01:14:22where strain restraints were not
• 01:14:24optimally used in in the care of
• 01:14:27a particular patient or patients.
• 01:14:30But on the other hand,
• 01:14:31the data are what the data are.
• 01:14:33And the data overall suggest that if you
• 01:14:37adjust for the rate of assaultive behavior,
• 01:14:41that there's not a differential
• 01:14:43use of restraints. By race,
• 01:14:45so I think we have to dig deeper into that.
• 01:14:50I mean, I think that's not the
• 01:14:52the the final answer,
• 01:14:54but perhaps the answers are going to
• 01:14:57come in between your personal experience,
• 01:15:00which is likely to be an experience
• 01:15:03that other people have as well.
• 01:15:05And these data that I described,
• 01:15:07which you know provide another perspective,
• 01:15:11and I, but my suspicion is that is that.
• 01:15:16Uhm?
• 01:15:17That the answers are not simple and and
• 01:15:21that's one of the reasons that that
• 01:15:25the kind of ongoing work that that.
• 01:15:30Sindy described as taking place on
• 01:15:32LV two and other inpatient units
• 01:15:35is important to continue and to
• 01:15:38work on on both the climate on the
• 01:15:42units and to work on.
• 01:15:47Getting a better understanding and
• 01:15:49develop better interventions for
• 01:15:52patients who are at risk for violence. I
• 01:15:54would just add a caveat to that
• 01:15:57that the data also showed that
• 01:15:59for patients who do not assault,
• 01:16:02there is a disparity that black and brown
• 01:16:07patients are restrained at a greater rate.
• 01:16:11So I think it's complex.
• 01:16:13There are many sort of
• 01:16:15facets and and pieces to it,
• 01:16:17and that that's why there's ongoing work to
• 01:16:21really understand and unpack the data, but.
• 01:16:24Importantly to think about
• 01:16:26what are the responses.
• 01:16:28And I can't just enough that there are
• 01:16:31responses at multiple levels at LV two
• 01:16:33and the hospital as well as others,
• 01:16:36but but also a willingness to to look
• 01:16:38at the data and to recognize challenges.
• 01:16:41And I think that that is.
• 01:16:43You know an important piece of it,
• 01:16:45and and the willingness to to put
• 01:16:48innovation in the innoventions
• 01:16:50and supports in place so.
• 01:16:55Yeah, thank you for that amendment, Cindy.
• 01:16:57I'm an outside also like to to to
• 01:17:00get back to to a comment or question
• 01:17:04earlier about about the diversity.
• 01:17:07Chief residents and their positions
• 01:17:09and how they're structured and
• 01:17:11and just say that this is.
• 01:17:14Something that we we can explore and I don't.
• 01:17:19You know I don't.
• 01:17:22Know the full details about how the Diversity
• 01:17:24Chief resident positions were created,
• 01:17:27but this is something that
• 01:17:28Doctor Blitz can I can.
• 01:17:30Can discuss.
• 01:17:31Great, thanks John.
• 01:17:38So I I there are a lot of, uh,
• 01:17:40questions and comments in the chat.
• 01:17:43I know we're just about out of time,
• 01:17:46so uhm, I'm happy to engage folks.
• 01:17:50And some of these separately,
• 01:17:53but we also have additional grand
• 01:17:56rounds as I mentioned for this
• 01:17:58year or three more after today.
• 01:18:01And so, you know, we can pick up
• 01:18:03some of the conversation there,
• 01:18:06but I'm also happy to talk.
• 01:18:08Through some of the questions
• 01:18:10and comments with folks come
• 01:18:12separately outside of this meeting.
• 01:18:14I just want to be respectful of folks time.
• 01:18:20John, I don't know if you have any.
• 01:18:21Closing comments, thoughts?
• 01:18:25Yeah, so uhm. Yeah mate,
• 01:18:28I I guess my. My my my.
• 01:18:32A couple of comments. First, Cindy,
• 01:18:35thank you for really great presentation.
• 01:18:37Really thorough, very careful, very.
• 01:18:40Thoughtful and and I,
• 01:18:42I think we've all learned a lot from
• 01:18:45it so so thank you for doing that.
• 01:18:48And not only for the presentation,
• 01:18:49but your leadership and and your
• 01:18:52collaborations with everybody in
• 01:18:54this space have been really important
• 01:18:56to our our effort to improve
• 01:18:59the climate of the department.
• 01:19:00In our practices.
• 01:19:02The second thing is, you know,
• 01:19:05I I appreciate that kind of
• 01:19:07discussion that we had in the
• 01:19:09time that we had in this session.
• 01:19:11The work of the task force.
• 01:19:14Is most meaningful if if it
• 01:19:18doesn't stay in the task force,
• 01:19:19but really is part of the daily
• 01:19:21life of our department and that
• 01:19:24means having a lot of difficult
• 01:19:26discussions broadly in the department,
• 01:19:28not just in the task force.
• 01:19:30And and I really appreciate the issues
• 01:19:34that that people brought up today.
• 01:19:37And and I look forward to the upcoming.
• 01:19:45And.
• 01:19:45A grand rounds that we're going
• 01:19:47to have related to the work of
• 01:19:50the task force where we'll drill
• 01:19:51down more into the work of the
• 01:19:54subcommittees and more deeply
• 01:19:56engaged specific issues like the
• 01:19:58issue of use of restraints which
• 01:20:01would fall in domain of the of
• 01:20:04the clinical task force so.
• 01:20:08Thank you everybody and look forward
• 01:20:10to continuing the discussion.