By Amy Beck, Ph.D., RYT 200
The novel virus COVID-19 disproportionately harms persons, including children, of color (Goyal et al., 2020; Shelton et al., 2020). This increased harm differentiates via the existing interpersonal, institutional, and structural/systemic pathways of racism, a social determinant of health (Krishnan et al., 2020). This is because of experiences such as negative biases and beliefs towards persons of color by healthcare providers which impact treatment, decreased access to healthcare, increased rates of chronic diseases that worsen COVID outcomes (i.e. obesity, diabetes), and sequalae of poverty (Cooper & Williams, 2020; Hall et al., 2015). With this increased harm, there is a greater mental health impact, such as traumatic stress due to loss of loved ones to the virus or having personally battled it, possible loss of income, and the cumulative trauma of another experience of racism (Cooper & Williams, 2020). Unsurprisingly, there is an association between experiences of racism in childhood and adolescence, particularly when cumulative, and later mental and physical health outcomes. The impact on mental and behavioral health outcomes, such as depression, self-esteem, anger/aggression, and substance use, is typically more pronounced (Cave et al., 2020; Madubata et al., 2019).
The scourge of racism is not novel in the United States, so what is our responsibility as pediatric psychologists to address it? Simply put, our Ethics Code states that psychologists are “committed to…improve the condition of individuals, organizations,” and that we are to aspire to the principles of beneficence, nonmaleficence, justice, and respect for people’s rights and dignity (American Psychological Association, 2017). Trying to change over 400 years of history can feel overwhelming, so below are a few practical steps to continue to wake up and promote change:
If you are one of the 80-90% of pediatric psychologists who does not identify as a person of color, simply start with a personal reflection: “Imagine how you would feel in mind, body, and heart if, after generations of peaceful protest and legal advocacy, innocent people from your community were still being killed and brutalized (from the virus or other forms of violence) with such horrifying regularity, simply because of skin color? Imagine stepping into the skin of the mothers, fathers, sisters, brothers, children, or families of someone who has died from these causes. What do you experience in your body, mind, and heart? What feelings or thoughts arise? Notice from your bodily sensations what actions feel urgent. How clear are you about taking those actions?” (King, 2020).
Within your clinical practice: assess patients/families for stressors associated with race, such as bullying, violence including microaggressions, and other negative experiences secondary to racial discrimination, as well as related symptoms such as traumatic stress, lower self-esteem, and suicidality (Madubata et al., 2019; Trent et al., 2019). Actively promote racial socialization, which is the process through which children learn about race, to help develop racial identity and positive self-concept, and grow resilience (American Psychological Association, 2018).
Within your research efforts: define the sociopolitical construct of race during experimental design and make clear the reason for its inclusion. Call racism out by name and type, mechanism of action, as well as intersectional factors that have impact. Solicit patient and community input to ensure meaningful benefit from the study for the population. Describe possible implications of outcomes on public policy and clinical practice (Boyd et al., 2020).
Within your training programs: teach trainees to integrate race and culture considerations as standard to conceptualization and treatment for all patients. Make these conversations a standard part of supervision and didactic education. Discuss the gaps and limitations in some evidence-based practices as they may apply to patients and families of color. Foster cultural humility by modeling ongoing learning, openness to change, and willingness to examine personal biases (Foronda et al., 2016). This video is a brief overview of some of the improvements that my institution has been working on, and an example of the above: https://youtu.be/wS7t8iJ6Dko.
Within your institution: actively pursue and promote not only implicit bias awareness training, but training on how to intervene when bias or harassment unfolds in real time. Hold leaders accountable for diversity efforts. For example, requesting that diversity efforts be a part of a leader’s performance review can incentivize leaders to promote diversity initiatives, and making these expectations publicly known increases the value of this work (Crews & Wesson, 2018).
Within SPP: recognize that the diversity of our society does not adequately represent the diversity of the patients who we serve. Efforts are expanding to actively grow pediatric psychologists of color, starting from the undergraduate level through graduate school—get involved if you are not already. Think beyond the legacy and powerhouse programs to develop opportunities for minority students who may never have access to them. Familiarize yourself with the established inequities within the EPPP and internship selection process (Bowman & Ameen, 2018; Ellis et al., 2020). Consider opportunities to amplify existing psychologists of color, such as by mentoring or leadership training. Recognize the trauma that may exist for your fellow colleagues of color, especially this year (I’ve written an Op Ed on my personal experience: www.kevinmd.com/blog/2020/08/my-intersection-of-race-and-privilege-with-covid-19.html).
- As an American citizen: make it a priority to vote in all local and national elections. As we have seen this year, every single vote counts and can be the difference maker. And recognize that change requires the meaningful effort of everyone. If change could occur by only the efforts of persons of color, it would have been completed by now. Continually attempting to create change without the authentic work and support from holders of societal privilege only places continued undue burden on persons of color. It truly must be all hands intentionally on deck, because as Dr. Martin Luther King Jr. stated decades ago, “Injustice anywhere is a threat to justice everywhere.”
Happy Holidays, and here is to a safer and more equitable 2021!
American Psychological Association. (2017). Ethical principles of psychologists and code of conduct (2002, amended effective June 1, 2010, and January 1, 2017). https://www.apa.org/ethics/code/
American Psychological Association. (2018). RESilience: Uplifting youth through healthy communication about race. https://www.apa.org/res/
Bowman, N., & Ameen, E. (2018). Exploring differences in pass rates on the Examination for Professional Practice in Psychology. Communique.
Boyd, R. W., Lindo, E. G., Weeks, L. D., & McLemore, M. R. (2020). On racism: A new standard for publishing on racial health inequities. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/
Cave, L., Cooper, M. N., Zubrick, S. R., & Shepherd, C. C. J. (2020). Racial discrimination and child and adolescent health in longitudinal studies: A systematic review. Soc Sci Med, 250, 112864. https://doi.org/10.1016/j.socscimed.2020.112864
Cooper, L. A., & Williams, D. R. (2020). Excess Deaths From COVID-19, Community Bereavement, and Restorative Justice for Communities of Color. Jama, 324(15), 1491-1492. https://doi.org/10.1001/jama.2020.19567
Crews, D. C., & Wesson, D. E. (2018). Persistent Bias: A Threat to Diversity among Health Care Leaders. Clin J Am Soc Nephrol, 13(11), 1757-1759. https://doi.org/10.2215/cjn.07290618
Ellis, J., Otugo, O., & Landry, A. (2020). Interviewed while Black. N Engl J Med. https://doi.org/10.1056/NEJMp2023999
Foronda, C., Baptiste, D. L., Reinholdt, M. M., & Ousman, K. (2016). Cultural Humility: A Concept Analysis. J Transcult Nurs, 27(3), 210-217. https://doi.org/10.1177/1043659615592677
Goyal, M. K., Simpson, J. N., Boyle, M. D., Badolato, G. M., Delaney, M., McCarter, R., & Cora-Bramble, D. (2020). Racial and/or Ethnic and Socioeconomic Disparities of SARS-CoV-2 Infection Among Children. Pediatrics, 146(4). https://doi.org/10.1542/peds.2020-009951
Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health, 105(12), e60-76. https://doi.org/10.2105/ajph.2015.302903
King, R. (2020). What compassion looks like today. Ten Percent Happier. https://www.tenpercent.com/meditationweeklyblog/what-compassion-looks-like-today
Krishnan, L., Ogunwole, S. M., & Cooper, L. A. (2020). Historical Insights on Coronavirus Disease 2019 (COVID-19), the 1918 Influenza Pandemic, and Racial Disparities: Illuminating a Path Forward. Ann Intern Med, 173(6), 474-481. https://doi.org/10.7326/m20-2223
Madubata, I., Spivey, L. A., Alvarez, G. M., Neblett, E. W., & Prinstein, M. J. (2019). Forms of Racial/Ethnic Discrimination and Suicidal Ideation: A Prospective Examination of African American and Latinx Youth. J Clin Child Adolesc Psychol, 1-9. https://doi.org/10.1080/15374416.2019.1655756
Shelton, J., Shastri, A., Ye, C., Weldon, C., Filshtein-Somnez, T., Coker, D., Symons, A., Esparza-Gordillo, J., Aslibekyan, S., & Auton, A. (2020). Trans-ethnic analysis reveals genetic and non-genetic associations with COVID-19 susceptibility and severity. https://doi.org/10.1101/2020.09.04.20188318
Trent, M., Dooley, D. G., & Dougé, J. (2019). The Impact of Racism on Child and Adolescent Health. Pediatrics, 144(2). https://doi.org/10.1542/peds.2019-1765