2020-07-15 social class bias webinarslides · 7/15/2020 · treatment outcomes 1 social class bias...

Cultural Humility Series, Part II 7/15/2020

Social Class Bias and the Negative Impact on Treatment Outcomes 1

S O C I A L C L A S S B I A S A N D T H E N E G A T I V E I M P A C T O N

T R E A T M E N T O U T C O M E SC u l t u r a l H u m i l i t y S e r i e s , P a r t I I

Welcome, your facilitator will be: Samson Teklemariam, LPC, CPTM

• Director of Training and Professional Development for NAADAC

• NAADAC, the Association for Addiction Professionals

• www.naadac.org

• [email protected]

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www.naadac.org/webinars

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Using GoToWebinar(Live Participants Only)

� Control Panel

� Asking Questions

� Audio (phone preferred)

� Polling Questions

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Bita Rivas, EdD, LPC, LMFT, LAC, MAC

• Assistant Professor at California State University Sacramento

• Doctorate degree in Counselor Education & Supervision

NAADAC Webinar Presenter

Anthony Rivas, EdD, LMFT, LAC, MAC, SAP

• Assistant Professor at California State University Sacramento

• Doctorate degree in Educational Leadership

NAADAC Webinar Presenter

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Social Class Bias and the Negative Impact on Client Treatment

OutcomesAnthony Rivas, Ed.D., LMFT, LAC, MAC, SAP

California State University, Sacramento

Bita Ashouri Rivas, Ed.D., LPC, LMFT, LAC, NCC, MAC, ACSCalifornia State University Sacramento

Content of this Presentation

Definition Intergenerational Poverty

Neurological implicationsPsychological implications

Wealth & Privilege

Implications for Clinicians

Structures for Support/Change

Agents

Resources

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What is Social Class?

• An expression of socioeconomic status (SES)

• An expression of identity for every human being regardless of country of origin, ethnicity, or culture

• An undeniable reality with its implicit and overt rules of behavior as well as its social ramifications for breaching these conventions

(Belmi et al., 2019; Borrego, 2003; Dubois et al., 2015; Fast, Sivanathan, Mayer, & Galinsky, 2012; Ishitani, 2003; Kraus et al., 2009; Wells & Zinn, 2004; Yeskel, 2008)

Implications of Social

Class

• Social class in an inherent aspect of ‘being’• Social class carries with it implicit and overt

rules of behavior• Boundaries and social ramifications for

members of that particular class group• “Social class is one of the least discussed-

most significant- issues in American life. Although rarely mentioned, perceptions of one’s social class status strongly affect how people feel about themselves, about others, and about their families”(Ross, 1995, p. 338)

• Commodification of individuals• Cultural mismatch theory

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Manifestation of Classism within the Individual

Internalized Classism• Individual feels myriad of negative cognitive and emotional

experiences related to fear of failure to maintain one’s social class standing

Upward Classism• Thoughts or feelings directed at those assumed to be at a higher

social class• May be viewed as “uppity” “snobby” or “bougie”

Downward Classism• Thoughts or feelings directed at those perceived to be in a lower

class• May be viewed as “lazy” “trashy” or “unworthy”

Lateral Classism• Those who are perceived as a similar social class, maintenance of

homeostasis. • “Keeping up with the Joneses” • Accompanying fear of losing status

Keeping up with the JonesesHow comfortable do you feel sharing the following?• Your income

• Your debt

• Talking about your student loan debt

• Kind of beer you drink

• Kind of wine you drink

• Are you behind on bills

• What is your credit score

• Have you ever been bankrupt

• What is your zip code

• What is your school district

• Do you buy generic

• Do you buy boxed/canned foods

• What does your house cost

• Where do you shop for groceries

• Where did you go to school

• Neighborhood you grew up in

• What kind of car do you drive

• What brands are you wearing now

• How sophisticated is your lexicon

• What restaurants do you frequent

• Do you vacation

• Where do you vacation to and how often

• Can you purchase something big or do you need to wait

• Do you live paycheck to paycheck

• Do you bring lunch to work

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Identity

Individuals from high SES positions view themselves more favorably

Feel they have more power

Score higher on self-esteem & narcissism scales

Demonstrate over precision

(Belmi et al., 2019; Dubois et al., 2015; Fast, Sivanathan, Mayer, & Galinsky, 2012; Judge, & Hurst, 2007; Kraus, & Park, 2014; Martin, Cote, & Woodruff, 2016; Piff, 2014)

Intergenerational Poverty

• Poverty as a risk factor• Academic failure

• Substance use

• Antisocial behavior

• Depression

• Teenage pregnancy

• Outcomes Mediated by • Adverse social environments

• Family

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Neurological Implications of Poverty

HPA Axis & CortisolHypothalamic-Pituitary-Adrenal Axis

Brain Development under stress-children

Cognitive abilities such as self-regulation also play a key role in the intergenerational cycle of poverty.

Psychological Implications of Poverty

ACE SCORE TRAUMA/STRESS RESPONSE

“ALLOSTATIC LOAD”

SUBSTANCE USE ANTISOCIAL BEHAVIOR

EDUCATION

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Wealth & Privilege

Overprecisionor having an excessive faith in knowing the truth in the absence of said knowledge

Overt & Covert Behaviors

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Polling question 1What are some traits associated with this group A. They are well read

B. They eat healthy

C. They own reliable transportation

D. They own their own home

E. They are reliable and trustworthy

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B. They eat healthy




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B. They eat healthy




Systemic Bias & Implications

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DRUGS

• Name the first population that comes to mind when you hear a prompt.

• Cocaine

• Crack

• Methamphetamine

• Heroin

• Krokodil

• Marijuana

• Rx opioids

• Inhalants

• Benzodiazepines

Polling question 4What SES is associated with wine

A. Low/ working class

B. Middle

C. Upper

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Polling question 5What SES is associated with prescription pills

A. Low/ working class

B. Middle

C. Upper

Implications of Bias in Legislation

• "The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people…You understand what I'm saying? We knew we couldn't make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin. And then criminalizing both heavily, we could disrupt those communities,…We could arrest their leaders. raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.

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War on Drugs

• Cocaine/Crack• Brought through US communities through governmental activities (Iran-Contra Scandal)

• Media representation of inner-city communities as criminals and drug addicts• Making crack synonymous with black communities & cocaine synonymous with white

communities

• 1986 Anti-Drug Abuse Act• Mandatory minimums

Implications for Clinicians

• Recognizing poverty and intergenerational trauma effects on individuals, families, children

• Recognizing implicit bias

• Operation in silo vs systemically

• Family of Origin of therapist • FOO/SES with occupation/Population

specialization/training

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Unconscious Bias Pathway

Implicit Bias Pathway

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RESTART Program

• 60 days in jail, with group therapy

• IOP approx. 20 hrs of services per wk (UA, probation, indv tx, group tx)

• Breathalyzer, random UA, SCRAM

• Lose license for 1 year

• Interlock and car insurance

• Must be employed full time

Access To Healthcare

DIAGNOSIS AND ACCESS TO SERVICES (PATIENTS/CLIENTS)

ASSESSMENTS & READING LEVEL

HOSPITALIZATIONS MENTAL HEALTH & TREATMENT OUTCOMES

MEDICAID EXPANSION

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Mental Health

• According to SAMHSA

• In 2018 47.6 million adults were diagnosed with AMI• 9.2 million of these were diagnosed with a co-occurring disorder

• 4.7 million (51.4%) received treatment for their co-occurring disorders (mental health & substance)

• 4.5 million (48.6%) did not receive services

Unemployment Rates

• Currently there are 20,348,500 (seasonally adjusted) unemployed individuals in the United States.

• According to SAMHSA in 2013, rates of substance abuse among were higher among unemployed individuals.

• Adults on parole or supervised release had a prevalence of 34.3% vs. counterparts not on parole or supervised release 8.4%.

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Structures Needed

for Support

Children ACEBasic Needs

SchoolsTrauma-Informed CurriculaPromoting Pro-Social Behavior

Families Resources

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Let’s Practice

• The Game: Spent, make it through 30 frames

• Please take you phone and type the following address:

• http://playspent.org/

Resources

PBS: Poor Kids:http://www.pbs.org/wgbh/frontline/film/poor-kids/

TIP 57: Trauma Informed Care (SAMHSA)

Implicit Association Test: https://implicit.harvard.edu/implicit/takeatest.html

Ardell wellness stress scale

Stress Reaction Inventory

ACE & Resiliency Scales

Columbia Suicide Severity Rating Scalehttps://suicidepreventionlifeline.org/wp-content/uploads/2016/09/Suicide-Risk-Assessment-C-SSRS-Lifeline-Version-2014.pdf

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Questions & Discussion

Contact:

Anthony Rivas, Ed.D., LMFT, LAC, MAC, SAP

California State University Sacramento

[email protected]

Bita Ashouri Rivas, Ed.D., LPC, LMFT, LAC, NCC, ACS

California State University Sacramento

[email protected]

Thank You! Any Questions?

Anthony Rivas, EdD, LMFT, LAC, MAC, SAP

Metropolitan State University of [email protected]

Bita Rivas, EdD, LPC, LMFT, LAC, MACCalifornia State University

[email protected]

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www.naadac.org/cultural-humility-social-class-bias-webinar

Cost to Watch:Free

CE Hours Available:2.0 CEs

CE Certificate for NAADAC Members:Free

CE Certificate for Non-members:$25

UPCOMING WEBINARS

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July 17th, 2020

Cultural Humility Series, Part III: Do You Know Who You Are and For Whom You Provide Services?By: Janice E. Stevenson, PhD


July 22nd, 2020

Measurement Based Care: An Essential Component of High-Quality Behavioral HealthcareBy: Julia S. Finken, RN, MBA, CSSBB, CPHQ


July 29th, 2020

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By: Allison (Alli) Schad, LCSW, LCAS, SEP & Peter Pennington, LPC, NCC


August 5th, 2020

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By: James Campbell, LPC, LAC, MAC, CAC II and Celeste H. Hutchinson, MA, LPC, NCP, MAC

www.naadac.org/webinars

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Cultural Humility Series





www.naadac.org/cultural-humility-webinars

• Cultural Humility Series, Part I: Understanding SUD Disparities Among LGBTQIA PeopleBy: De’An Roper, PhD, LCSW-S

• Cultural Humility Series, Part II: Social Class Bias and the Negative Impact on Client Treatment OutcomesBy. Anthony Rivas, EdD, LMFT, LAC, MAC, SAP and Bita Rivas, EdD, LPC, LMFT, LAC, MAC

• Cultural Humility Series, Part III: Do You Know Who You Are and For Whom You Provide Services?By: Janice Stevenson, PhD

• Cultural Humility Series, Part IV: Critical Issues in LGBTQIA Patient CareBy: Allison (Alli) Schad, LVSW, LCAS, SEP and Peter Pennington, LPC, NCC

• Cultural Humility Series, Part V: Race, Ethnicity and Immigration: SUD Treatment for Latinx CommunitiesBy: Pierluigi Mancini, PhD, MAC, NCAC II

• Cultural Humility Series, Part VI: Why It Matters Now More Than EverBy: Miguel E. Gallardo, Psy.D.

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2020-07-15 social class bias webinarslides · 7/15/2020 · treatment outcomes 1 social class bias...

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