Overcoming Diagnostic Biases in Community Mental Health Settings

1. Overcoming Diagnostic Biases in Community Mental Health Settings Armando Gonzalez-Cort Psy.D., Tatiana Glebova Ph.D., Diana White MA, & Gwenyth Poggi MA California School of Professional Psychology at Alliant International University Data Gathering & Analysis The community based agency provides outpatient services for families of low socioeconomic status. An action research model was used to organize a meeting between the researchers and the agency’s leaders and clinicians to discuss the findings of the quantitative study. Within the two and a half hour meeting the results of the study were presented to staff, and a dialogue session was facilitated in order to solicit reactions to help better understand what factors might have contributed to these unique results. A phenomenological model of analysis was loosely used to categorize the dominant and reoccurring themes that emerged from the group dialogue. • Conclusions • Our findings point to the importance of the following factors in minimizing gender and race biases in youth’s diagnosis. • Agency Culture • Isomorphism and congruency in agency leadership • Overall agency culture that contributes to and honors cultural sensitivity • Leveling out power differential in management hierarchy • Leadership direct connection with the community served • Values shared by all team members • Empowerment of therapists • Collaborative Diagnoses • Clinicians who work directly with clients have a strong voice in diagnosis formulation • Philosophies Guiding the Diagnostic Process • Relationships as a foundation of successful functioning • Consideration of contextual factors • Continuous deconstruction of DSM diagnoses • Consideration of life consequences of diagnosis and taking responsibility for that • Introduction • Prior research has shown that while diagnoses is vital to determining a youth’s eligibility for services, it often comes with the inherent risk of exposing youth to stigmatization within society, and carries the potential of lending to future social dysfunction (Pottick, Kirk, Hsieh, & Tian, 2007). These studies suggest that specific client characteristics such as gender and race have a strong impact on determining which diagnoses are given to youth. More specifically, it has been found that males and racial minorities are more likely to be given restrictive and stigmatizing diagnoses in comparison to females or White youth. • In spite of these mostly consistent findings, our recent quantitative study with a California community based agency produced results that contradicted these trends, showing a lack of statistically significant relationship between a youth’s diagnosis and their gender or race (Poggi, G., Gonzalez-Cort, A., & Glebova, T.. “Role of Characteristics on Diagnoses Given to County Youth.”Poster AAMFT , 2012). • Purpose of this project • Explore factors contributed to overcoming gender and race biases in youth’s diagnosis in community mental health settings. • Results • In our meeting with the agency members three categories of factors that have helped to minimize biases in clinical diagnoses of the youth emerged. • Agency Culture • Commitment to Leveling out Power Differential in Management Hierarchy: Management in the agency makes a point to level out the power differential between themselves and clinicians on staff. To achieve this objective all management, including the CEO, interfaces with the clients they serve. Additionally, the CEO has an open door policy that encourages all staff and clients to come directly to him with questions, complaints or feedback. • Putting Agency’s Core Values into Practice: As part of implementing a cultural strength-based model of empowerment the agency believes in collaborating with, and learning from, the community they serve. To this end, the agency has created community groups designed to create community solidarity around neighborhood critical issues, and to allow staff opportunities to develop a deeper level of understanding for the communities they serve. • Collaborative Diagnoses • Team Oriented Approach to DSM Diagnoses: Clinicians, psychiatrists and supervisors meet to collaborate on diagnoses for clients. In these meetings the clinician’s voice is honored, and often privileged, with respect to that of the psychiatrists and management due to the clinician’s unique perspective developed from spending the most time interfacing with the client and family. • Philosophies Guiding the Diagnostic Process • Honoring Contextual Variables and Heightened Awareness to Limitations and Consequences of Diagnoses: Management within the agency stresses the inherent limitations in the diagnostic process (overlapping of symptomology, inconsistencies and bias) in order to heighten clinician’s respect for contenxtual variables that contribute to symptomology, and to also stay congruent to their overarching strength based values seeking to honor their client’s resourcesfulness.