Benchmarks' Partnering for Excellence (PFE) works to address the needs of child welfare involved youth and families by proactively connecting individuals to appropriate trauma-intensive assessments and treatment. One facet of exploration for Benchmarks is using data from PFE to examine racial disparities in mental health assessment and diagnosis in our PFE counties. It is known that connecting our youth and families to the most effective treatment lies in the hands of a great assessment. But can assessments be great if bias is involved? Last month, Benchmarks was excited to host the first Special Topics Webinar of the year with guest speaker Dannette McCain who discussed racial equity in assessments. Dannette McCain has "over 20 years of experience working with high-risk/high promise youth and families in education, juvenile justice and community-based programs." She facilitated a thought-provoking webinar that encouraged clinicians and child welfare workers in attendance to think critically about racial bias and how it can affect clinical assessments for our youth.
Dannette’s first step was to help the group understand the difference between implicit and explicit bias. Explicit biases are the ideas, attitudes, opinions, and feelings we outwardly share with the world. These are easy to identify. In contrast, implicit biases are the quick, unconscious judgements that humans make about others based on limited, “tip-of-the-iceberg” information such as age, dress, race, gender, and other physical characteristics. We all have biases, and our biases are shaped by our own individual experiences and cultural conditioning. Our brains are wired to form these quick “tip-of-the-iceberg” judgements upon meeting and interacting with others. But Dannette reminded us that this fast-acting part of the brain is also error prone. If left unchallenged, we may accept our implicit biases as fact.
It is especially important for those in the mental health field to address their implicit biases, so these biases do not affect assessments. We all have individual, unique experiences which shape our perceptions of the world and others. In the world of child welfare, discussions about disparities tend to center around race and poverty. We looked at child welfare data that reflected the tendency for minority children to be taken into custody much sooner than their Caucasian peers who came from similar situations. Through data, we also saw racial disparities in diagnoses between African American and Native American children and their Caucasian peers. Caucasian children coming from similar situations as their minority peers were more likely to be given a diagnosis of Post Traumatic Stress Disorder (PTSD) while African American children are more likely to be given a diagnosis of Conduct Disorder or Oppositional Defiant Disorder. We know diagnosis informs treatment and can impact what other systems our youth may become involved in. This can have major implications on our youth and their outcomes so why are we addressing trauma for one group and not the other? The disheartening data leads us to and ask more questions. Are there racial and/or cultural differences in how parents or teachers describe the behaviors of our children? Is it society that harbors biases around our minority children, or even our children in general? How big of a role does racial bias play in our child welfare and mental health systems and the ways that they provide services to children and families from different backgrounds?
Even the most skilled clinician who approaches their work with objectivity can unknowingly incorporate their implicit biases when working with clients. So, what can we do manage our biases? Dannette reminds us to take care of ourselves first, “When you are exhausted, you’re much more likely to fall back on your biases. Be aware of this and check yourselves.” Along with self-care, Dannette encouraged the use of valid and reliable tools in clinical work and assessments that are developed and tested to remove bias. It is always important to practice self-reflection and check your motivation – ask yourself “why am I thinking this way?” and “what experiences have I had that may have led me to think like this?” when working with clients. And lastly, try not to fall victim to our “fast brain” that is wired to fill in the blanks so quickly; ask questions so you can gather all the information you need to get the big picture. When we are mindful of our biases, we can provide accurate assessments that will guide our youth to the services that best serve their individual needs, focus on their well-being, and promote better life outcomes overall.
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