Yale Psychiatry Grand Rounds: September 17, 2021

September 17, 2021

Information

"Department of Psychiatry Anti-Racism Task Force Community Update"

John H. Krystal, MD, Robert L. NcNeil, Jr. Professor of Translational Research and Professor of Psychiatry and of Neuroscience; Chair, Yale Department of Psychiatry

Cindy Crusto, PhD, Professor of Psychiatry; Deputy Chair for Diversity, Equity and Inclusion, Yale Department of Psychiatry

ID6909

To CiteDCA Citation Guide

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.