Truth and reconciliation for whom? Transitional justice for Indigenous peoples in American psychology.

In October 2021, the American Psychological Association apologized to people of color in the United States for its role in systemic racism. Spurred by a national racial reckoning, Indigenous Peoples have been regularly incorporated into initiatives redressing America's legacy of racism. Although Indigenous Peoples have been racialized during the formation of the United States, this process is intertwined with colonization-the systematic dispossession and exploitation of Indigenous communities by Europeans. We first examine how the American Psychological Association (APA) has been complicit in colonialism by failing to oppose government policies that disenfranchise Indigenous communities, which it recently recognized in a separate apology to First Peoples in the United States in February 2023 (American Psychological Association, APA Indigenous Apology Work Group [APA IAWG], 2023). Second, we explore methods for APA to reconcile historical and contemporary wrongs inflicted on Indigenous Peoples through transitional justice, an approach to addressing human rights violations that seeks justice and opportunities for healing (United Nations, 2008). In particular, we consider the implications that Truth and Reconciliation Commissions have for Indigenous Peoples. Third, we provide recommendations for APA to repair relations with Indigenous Peoples in education, research, and practice. We specifically interrogate what possibilities for truth, reconciliation, and healing exist vis-à-vis transitional justice in psychology. We conclude with the potential that APA has to advance meaningful structural reforms while cautioning against superficial efforts towards reconciliation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Structural Racism in Newborn Drug Testing: Perspectives of Health Care and Child Protective Services Professionals.

PURPOSE: Black birthing parents and their newborns disproportionately experience newborn drug testing for prenatal substance exposure by health care professionals (HCPs), which contributes to Child Protective Services (CPS) reporting, family separation, and termination of parental rights. This qualitative study aims to interrogate dominant power structures by exploring knowledge, attitudes, and experiences of HCPs and CPS professionals regarding the influence of structural racism on inequities in newborn drug testing practices. METHODS: We conducted semistructured interviews with 30 physicians, midwives, nurses, social workers, and CPS professionals guided by an explanatory framework, and conducted inductive, reflexive thematic analysis. RESULTS: We identified 3 primary themes: (1) levels of racism beyond the hospital structure contributed to higher rates of drug testing for Black newborns; (2) inconsistent hospital policies led to racialized application of state law and downstream CPS reporting; and (3) health care professionals knowledge of the benefits and disproportionate harms of CPS reporting on Black families influenced their decision making. CONCLUSION: Health care professionals recognized structural racism as a driver of disproportionate newborn drug testing. Lack of knowledge and skill limitations of HCPs were barriers to dismantling power structures, thus impeding systems-level change. Institutional changes should shift focus from biologic testing and reporting to supporting the mutual needs of birthing parent and child through family-centered substance use treatment. State and federal policy changes are needed to ensure health equity for Black families and eliminate reporting to CPS for prenatal substance exposure when no concern for child abuse and neglect exists.

Childhood Behind Bars: Children and the US Juvenile Legal System.

This article examines the epidemiology of the US juvenile legal system, which disproportionately impacts youth with multiple marginalized identities and exacerbates health inequities. Policy changes that can improve the treatment of children who display disruptive behavior are highlighted, so as to lay out a path forward for supporting children and enhancing health equity while bolstering public safety. Finally, this article concludes that the systemic racism pervasive in the juvenile legal system signals an important role for pediatrics to advance racial equity and transform our approach to childhood.

Inclusion and anti-racism work as performance or deep work? It literally is either-or: A qualitative study in the CFT field.

This study explores the experience of promoting inclusion and anti-racism work as either performance or deep work in the couple and family therapy (CFT) field through narrative qualitative analysis. While performance-based approaches focus on meeting external expectations and diversity quotas, deep work involves critical self-reflection, ongoing learning, and a commitment to addressing systemic inequalities. The paper prioritizes how deep inclusion assists with developing new approaches to creating meaningful and lasting change in teaching, research, and clinical work in the CFT field. Some professionals in the field include educators, researchers, and therapists who are engaged in anti-racism work, a recognition of the impact of systemic racism on family dynamics and therapeutic interventions, and a commitment to centering the voices and experiences of marginalized individuals and communities. Implications present a need for ongoing education, training, and support for professionals in the CFT field and other family science and family mental health-related professions. This study also identifies limitations and future directions for research in promoting inclusion and anti-racism work in family science and family mental health-related fields. It is essential to promote inclusion and anti-racism as deep work to create more inclusive and equitable teaching, research, and therapeutic environments that value the experiences of all individuals and communities. Challenges include resistance from shaking systems and making ourselves and others vulnerable with uncomfortable and continuous conversations. Our primary goal is to contribute to and inspire dialogue about the perspectives CFTs and other mental health-related professionals are taking in the relationship to inclusion and anti-racism work.

Addressing anti-black racism in an academic preterm birth initiative: perspectives from a mixed methods case study.

BACKGROUND: Growing recognition of racism perpetuated within academic institutions has given rise to anti-racism efforts in these settings. In June 2020, the university-based California Preterm Birth Initiative (PTBi) committed to an Anti-Racism Action Plan outlining an approach to address anti-Blackness. This case study assessed perspectives on PTBi's anti-racism efforts to support continued growth toward racial equity within the initiative. METHODS: This mixed methods case study included an online survey with multiple choice and open-ended survey items (n = 27) and key informant interviews (n = 8) of leadership, faculty, staff, and trainees working within the initiative. Survey and interview questions focused on perspectives about individual and organizational anti-racism competencies, perceived areas of initiative success, and opportunities for improvement. Qualitative interview and survey data were coded and organized into common themes within assessment domains. RESULTS: Most survey respondents reported they felt competent in all the assessed anti-racism skills, including foundational knowledge and responding to workplace racism. They also felt confident in PTBi's commitment to address anti-Blackness. Fewer respondents were clear on strategic plans, resources allocated, and how the anti-racism agenda was being implemented. Suggestions from both data sources included further operationalizing and communicating commitments, integrating an anti-racism lens across all activities, ensuring accountability including staffing and funding consistent with anti-racist approaches, persistence in hiring Black faculty, providing professional development and support for Black staff, and addressing unintentional interpersonal harms to Black individuals. CONCLUSIONS: This case study contributes key lessons which move beyond individual-level and theoretical approaches towards transparency and accountability in academic institutions aiming to address anti-Black racism. Even with PTBi's strong commitment and efforts towards racial equity, these case study findings illustrate that actions must have sustained support by the broader institution and include leadership commitment, capacity-building via ongoing coaching and training, broad incorporation of anti-racism practices and procedures, continuous learning, and ongoing accountability for both short- and longer-term sustainable impact.

Understanding systemic racism: Anti-Blackness, white supremacy, racial capitalism, and the re/creation of white space and time.

In this article, the authors explain systemic racism through a racial-spatial framework wherein anti-Blackness, white supremacy, and racial capitalism interlock to create and recreate white space and time. Through the creation of private property, institutional inequities become embedded and structured for the benefit of white people. The framework provides a way to conceptualize how our geographies are racialized and how time is often used against Black and non-Black people of Color. In contrast to white experiences of feeling "in-place" almost everywhere, Black and non-Black people of Color continually experience displacement and dispossession of both their place and their time. This racial-spatial onto-epistemology is derived from the knowledge and experiences of Black, Indigenous, Latinx, Asian, and other non-Black people of Color, and how they have learned through acculturation, racial trauma, and micro-aggressions to thrive in white spaces and contend with racism such as time-theft. The authors posit that through reclaiming space and time, Black and non-Black people of Color can imagine and practice possibilities that center their lived experiences and knowledge as well as elevate their communities. Recognizing the importance of reclaiming space and time, the authors encourage counseling psychology researchers, educators, and practitioners to consider their positionalities with respect to systemic racism and the advantages it confers to white people. Through the process of creating counterspaces and using counterstorytelling, practitioners may help clients develop healing and nurturing ecologies that challenge the perniciousness of systemic racism. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Time to Abolish Metrics That Sustain Systemic Racism in Kidney Allocation.

This Viewpoint discusses how the Kidney Donor Profile Index (KDPI) in its current form is not fit to guide kidney allocation because it devalues organ donation by Black donors based on a weak association between donor race and kidney transplant failure.

Racismo e saúde mental: uma cartografia do trabalho com famílias / Racismo y salud mental: una cartografía del trabajo con familias / Racism and mental health: a cartography of a work with families

Resumo Este artigo é um desdobramento da tese de doutorado que trata das relações e processos de subjetivação entre equipes técnicas e famílias na rede de saúde mental. Neste contexto, o trabalho aborda forças conservadoras e possibilidades de resistência ao poder. O racismo está presente no cotidiano de pessoas que convivem com situações de sofrimento mental, mas poucas vezes esse marcador social é abordado nos serviços, caracterizando o silenciamento de experiências vividas. A metodologia utilizada foi a cartografia, incluindo pesquisa de campo, permitindo rastreamento de processos e considerando o posicionamento político de quem pesquisa, com orientação para práticas comprometidas com transformações sociais. A análise dos dados produzidos associa perspectiva interseccional sobre as demandas em saúde mental à esquizoanálise, buscando a construções de saída dos impasses entre familiares e equipes. Concluímos que sustentando indagações sobre modos de nos relacionar e revisitar nossa história, podemos construir práticas coletivas antirracistas na saúde mental.

Resumen Este artículo es fruto de una tesis doctoral que aborda las relaciones y los procesos de subjetivación entre los equipos técnicos y las familias en la red de salud mental. Aborda las fuerzas conservadoras y las posibilidades de resistencia al poder. El racismo está presente en el cotidiano de las personas que viven con sufrimiento mental, pero ese marcador social raramente es abordado en los servicios, caracterizando el silenciamiento de las experiencias vividas. La metodología utilizada fue la cartografía, incluyendo la investigación de campo, permitiendo rastrear procesos y teniendo en cuenta el posicionamiento político hacia prácticas comprometidas con la transformación social. El análisis de los datos asocia perspectiva interseccional de las demandas de salud mental con el esquizoanálisis, con búsquedas de salidas a los impasses entre familiares y equipos. Concluimos que apoyando preguntas sobre los modos de relacionarnos y revisitando nuestra historia, podemos construir prácticas colectivas antirracistas en salud mental.

Abstract This article is an offshoot of a doctoral thesis that deals with the relationships and processes of subjectivation between technical teams and families in the mental health network. In this context, it deals with conservative forces and possibilities of resistance to power. Racism is present in the daily lives of people who live with situations of mental suffering, but this social marker is rarely addressed in the services, characterizing the silencing of lived experiences. Cartography was the methodology used, including field research, which allows processes to be traced and takes into account the political positioning of the researcher towards practices committed to social transformation. The analysis of the data produced associates an intersectional perspective on mental health demands with schizoanalysis, seeking ways out of the impasse between family members and teams. We conclude that by supporting questions about ways of relating and revisiting our history, we can build anti-racist collective practices in mental health.

Mitigating structural racism to reduce inequities in sepsis outcomes: a mixed methods, longitudinal intervention study.

BACKGROUND: Sepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention. METHODS: Our aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis. DISCUSSION: This study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis.

Critical Perspectives to Advance Educational Equity and Health Justice.

A robust body of research supports the centrality of K-12 education to health and well-being. Critical perspectives, particularly Critical Race Theory (CRT) and Dis/ability Critical Race Studies (DisCrit), can deepen and widen health justice's exploration of how and why a range of educational inequities drive health disparities. The CRT approaches of counternarrative storytelling, race consciousness, intersectionality, and praxis can help scholars, researchers, policymakers, and advocates understand the disparate negative health impacts of education law and policy on students of color, students with disabilities, and those with intersecting identities. Critical perspectives focus upon and strengthen the necessary exploration of how structural racism, ableism, and other systemic barriers manifest in education and drive health disparities so that these barriers can be removed.

Disparities in Addiction Treatment: Learning from the Past to Forge an Equitable Future.

The Half-Century long problem of addiction treatment disparities. We cannot imagine addressing disparities in addiction treatment without first acknowledging and deconstructing the etiology of this inequity. This article examines the history of addiction treatment disparities beginning with early twentieth-century drug policies. We begin by discussing structural racism, its contribution to treatment disparities, using opioid use disorder as a case study to highlight the importance of a structural competency framework in obtaining care. We conclude by discussing diversity in the workforce as an additional tool to minimizing disparities. Addiction treatment should be aimed at addressing care delivery in the context of the social, economic, and political determinants of health, which require appreciation of their historical origins to move toward equitable treatment.

Addressing Structural Racism in Psychiatry With Steps to Improve Psychophysiologic Research.

Importance: The American Medical Association has acknowledged the public health threat posed by racism in medicine. While clinicians in psychiatry have echoed the sentiment, the research community has largely been silent. Current understanding of the biological domains that underlie psychiatric disorders was historically established by studying White populations, often leaving widely used treatments ineffective for Asian, Black, Hispanic, Indigenous, and other racial and ethnic minority individuals. This article addresses how undersampling of racial and ethnic minority individuals has led to overgeneralized physiological findings, the implications for development of psychiatric treatments, and steps to improve service to racially diverse communities. Observations: Three primary observations regarding differences associated with race and ethnicity have been addressed in the existing psychiatric research: misdiagnosis, medication nonadherence, and treatment efficacy and expression of adverse effects. While cultural factors have been discussed as potential factors associated with these differences, a lack of understanding of physiologic systems may be foundational to each of these issues. Recent evidence points to race differences in psychophysiological measures, likely attributed to factors including the lived experience of racism as opposed to inherent biological differences. This mounting evidence supports a reassessment of existing work to examine potential divergent patterns within racial and ethnic groups. The following strategies may improve understanding of the influence of racism on physiology, allowing clinicians to better address psychiatric symptoms and improve existing treatment approaches. Thus, psychiatric researchers need to (1) understand the historic and current terminology for race and ethnicity and use appropriate terms and categories as defined by sociologists, population health experts, and databases while respecting individuals' right to self-identify, (2) refine research questions, and (3) reexamine research data to determine whether patterns observed in largely White populations can extend to other groups. To appropriately implement these steps, researchers must accept the discomfort that accompanies growth, invite scientists from diverse backgrounds to participate, and use resources to increase diversity in recruitment of study participants. This will require a commitment from funding agencies to provide adequate support to recruit and investigate large, diverse samples. Conclusions and Relevance: To create more suitable medical treatments and improve the quality of care received by those with psychiatric conditions, further discussion is needed surrounding the physiologic toll that racism has had on multiple generations of racial and ethnic minority groups and how that may alter responsivity to biobehavioral interventions. To better inform psychiatric research, the resources provided must be expanded, basic physiologic studies should be replicated with more diverse samples and adequate analyses, and psychiatry scientists must reconsider approaches to clinical research.