An intensely difficult experience with a supervisor in her postdoc clinical internship at first confused Amber Childs. “I asked my colleagues and friends if they thought it could be racism. I had not wanted that to be the truth, but it was crystal clear.” Despite the damaging effects, the experience opened a new career pathway promoting diversity, equity, and inclusion (DEI) in the field. Ten years later, she works to ensure other interns have a healthier experience. An assistant professor of psychiatry at the Yale School of Medicine, Childs is the director of training for the Yale Doctoral Internship in Clinical and Community Psychology and executive director and cofounder of Yale’s innovative GROW (Getting Racism Out of our Work) Initiativeopens in new window.
The Monitor spoke with Childs about her work at GROW where she trains supervisors in the dynamics of power and privilege.
Tell us about GROW—how it started and how it’s going.
First, I want to give a shout-out to my GROW cofounders at Yale Medical School: Cindy Crusto, a professor of psychiatry, and Rebecca Miller, an associate professor of psychiatry. The initiative has three main components: data-driven cultural competency training for clinical leaders, research and evaluation, and mentorship and training for advanced trainees. For training, GROW’s cultural competency supervisor programs are offered to Yale’s supervisors of advanced trainees, doctoral interns, and postdocs in psychology and psychiatry. We ran a pilot in the 2021 to 2022 academic year in which faculty participants attended workshops covering foundations and concrete skills practice in key frameworks of culture and diversity, intersectionality, and cultural/structural competence, plus participants had the option to work in small groups to develop skills. Even the folks who were like, “I’m down for the revolution,” said they learned about themselves as cultural beings. But we also learned from what folks told us in the post-course survey, so the next year, GROW 2.0 added training in the history of racism in psychology, psychiatry, and medicine, along with evidence-based strategies for clinical supervision. We also required small groups and had them facilitated by trained external experts in culture and diversity. Supervisors in GROW 2.0 [45 in all] covered the six topics in six monthly didactics taught by powerhouse experts in DEI and met twice a month in groups of five or six, where they did things like role-play supervisor and supervisee with their trained facilitators. Participants also had access to curated online supplemental materials such as articles and book chapters.
At the APA 2023 Convention, we presented preliminary data showing that we’re getting a resounding “Yes!” from supervisors about the value of GROW. Across the data, the impact was clear: More than 94% reported increased competence in discussing power dynamics in supervision, 91.4% reported increased competence in discussing race and racism with trainees, 91.5% reported increased competency in discussing social determinants of health with trainees, and 83% reported a better understanding of race and racism in supervision in general.
What strategies do you teach in the GROW training that participants can directly incorporate into their work?
First, we talk about how to include our identities in the work because our identities are going to affect how we structure clinical work and supervision. For instance, we talk about how to think about the power and privilege that supervisors hold, and how to think about how our respective racial, cultural, and social identities work together within the context of that training relationship. Second, we talk concretely about how to open that first supervisory session and talk about power and identity—because it’s going to be there even if you don’t talk about it. Third, we talk about other domains such as gender, language of origin, ability, status, and how privilege and oppression are interwoven and intersecting within these different domains.
And it’s essential for all practitioners to do a structural analysis [consider how patients fit into a societal structure that may cause harm]. Everybody should be trained to think about social determinants of health—how they affect both patient care and our conceptualization of treatment.
Have you found that some practitioners assume racism is not a problem anymore?
One hundred percent, in part because we as a country have not been able to fully acknowledge and process the enduring and wide-sweeping impact of racism. Clinicians new to that discomfort [of grappling with racism] are tempted to lean solely on what they are trained to understand is happening for someone from a clinical standpoint. But we argue that clinicians cannot fully understand a person’s clinical presentation without also understanding the context in which that person lives. There’s a large, silent, ambivalent middle group that is not sure what actions to take in their equity work. We have to figure out what will compel them to move.
The idea is to get to that critical mass of that large ambivalent group and then reach the smaller group of folks who don’t believe racism is still a factor. We need to change the culture around them to the point where it’s not possible for them to continue having only one point of view.
What advice do you have for current and future psychologists and supervisors to “get racism out of the work”?
One: Know yourself. Understand how you’re positioned in society and in the discipline. Commit to having ongoing conversations with yourself and other people about power and privilege. Two: Be willing to be uncomfortable as you traverse new territory. Sometimes people get paralyzed by discomfort, but take it as a signal that you’re encountering and challenging old ways of thinking. Three: Be curious. It’s okay not to be an expert in this space, and, in fact, you’re probably not. But being curious and working through discomfort can move mountains.
What’s next?
Next, we will likely launch another round of our core program at Yale. But we also heard that supervisors need time and flexibility to participate in training given their demanding clinical schedules. So we’re developing GROW Seeds, a self-paced online program that distills material from the live program. We’ll extend it outside Yale to reach other psychology, psychiatry, and mental health discipline trainees. We’re also designing an online small-group facilitator training program to teach others how to facilitate GROW small groups to support our ability to practically scale these interventions where they’re needed most. We encourage folks to check in with us to see how things are coming along!
