The Department of Psychology at East Tennessee State University has established a program of clinical training designed to equip students with tools to address the behavioral and mental health needs of people located in the underserved communities surrounding the university. These communities comprise economically disadvantaged and strongly faith-based individuals located within rural Appalachia. In this way, the entire premise of the program is diversity-centered. Yet these three dimensions of individuality are but a subset of a much larger multidimensional spectrum of diversity with which the Department, through formal and informal experiences, attempts to ensure familiarity and sensitivity among all its staff and students. Included in this broader spectrum are, but are not limited to, race, ethnicity, age, sex, gender, sexual orientation, religious orientation, religion, disability status, socioeconomic status, and national origin. Below we describe the department's efforts to infuse attention and sensitivity to diversity through 1) a long-term, systematic plan for the recruitment and retention of diverse staff and students; (2) education of students; and (3) establishment of a climate of respect.
Long-Term Systematic Efforts at Recruiting and Retaining Diverse Staff and Students
In this first area our plans include a breadth of strategies for recruiting and retaining both diverse faculty and students. Currently we have 15 full-time faculty – 9 men and 6 women. Open faculty positions are advertised in both a general audience publication (i.e., the APA Monitor), and an African-American targeted publication (Psych Discourse). Every department advertisement is subjected to review and revision by ETSU's Affirmative Action Officer, Dr. Mary Jordan, who directs the Office of Equity & Diversity (http://www.etsu.edu/equity). The Office of Equity and Diversity oversees equity standards and university-wide education and training on diversity. All ads include a statement encouraging minorities and underrepresented groups to apply. In addition, departmental faculty distribute advertisements to colleagues in other psychology graduate departments and to various society listservs such as the Council of Graduate Departments of Psychology (COGDOP) and the Society for Personality and Social Psychology. In order to improve in the area of diversity recruitment, we plan to advertise future open faculty positions in additional listservs that would reach diversity-specific organizations (e.g., APA Divisions 44 (LGBT) and 45 (Ethnic Minority Issues)).
We continually strive to recruit diverse graduate students. Since the inception of the clinical doctoral program we have distributed marketing to over 500 colleges and universities nationwide, including 50 Historically Black Colleges and Universities (HBCUs), more than 70 Christian Colleges/Universities, and more than 50 Colleges and Universities that host a McNair. The program also utilizes a recruiter funded by the School of Graduate Studies who attends graduate school and career fairs at institutions which identify as serving historically underserved groups. The program individually corresponds with all contacts identified through this institutional recruitment. The program participates in student recruitment at professional conferences, such as the Collaborative Family Health Association, Rural Mental Health Association, and the Tennessee Psychological Association. In addition, with each cohort of potential students we recruit doctoral students who are sensitive to diversity issues particularly as they relate to a clinical setting. In this regard, as part of our group interviewing process, we ask a series of interview questions designed to gauge sensitivity to individual and cultural differences. To this end, we have received, on average, 42 applications for our program each year between 2007 and 2011. Table 2 indicates the diversity represented in our applicants, and in the demographics of the 28 students enrolled in various stages of the program during these years. Of the 28 current students, 8 (28.6%) are male, 2 (7.1%) report ethnicity that is non-White. The mean age of current students is 26 years, with some variability (range = 23 to 48). Three (10.7%) report some form of disability-related status.
In addition to student demographic diversity, with each cohort of potential students we recruit doctoral students who are sensitive to diversity issues particularly as they relate to a clinical setting. Thus, as part of a group interview of applicants, we ask a series of interview questions designed to gauge sensitivity:
Appalachian stereotypes include what things? How valid are these?What if someone came in for religious-based counseling?What kind of client/patient would you have the most difficulty working with and why?A male 15-year old is being brought to you by his parents because they are afraid he is gay. What factors are important to consider in working with this teen?What factors are important to consider when you work with a client of a very different ethnic or racial background from yourself?
In the spirit of striving to implement additional strategies for recruitment of diverse faculty and students alike, we believe a restructuring of the departmental website to highlight diversity will facilitate our efforts. According to research recently published in the Journal of Diversity in Higher Education (Wilson & Meyer, 2009), programs' websites have been referred to as the virtual face, and may be critical especially for minority students considering particular schools, as they can evaluate via the website as to whether that college or university takes their needs and interests into consideration.
Our restructured website will highlight the department's statement on diversity/inclusiveness, as well as departmentally-sponsored activities that relate to diversity, including open positions, speakers, and faculty and student activities (presentations, publications, projects). We will highlight, for example, Dr. Chris Dula, who, in collaboration with a Sociology faculty member, has been awarded a Diversity Grant from the Tennessee Board of Regents two years in a row. We will also highlight, Dr. Stacey Williams' recent research study on attitudes about sexual orientation. Finally, we will include a description of our recently implemented Priester-Sloan award, which is a graduate student scholarship for first year graduate students, awarded in large part based on financial need. The addition of this award to the website recognizes the struggles of students based on economic circumstance. Hence, a retooled website will help retain students while contributing to a climate of respect.
In addition to our efforts aimed directly at recruiting and retaining diverse faculty and students, we believe that our efforts to promote diversity, both formally, in our training curriculum, and informally, in the environments and climates we establish for them, will indirectly promote the recruitment and retention of diverse faculty and students. Indeed, we believe these two efforts mutually inform one another.
Education of Students
Our systematic plan to infuse diversity into the curriculum is a formal effort. For clinical students, we infuse discussion of diversity into the ethics course (PSYC5100). Further, both clinical and experimental students take an anthropology course on cultural and anthropologic applications related to mental health in rural Appalachia (PSYC7500). Clinical students gain further experience interacting with rural communities and working interprofessionally through the course "Rural Health Research and Practice" (PSYC5040), an inter-professional course which also enrolls nursing, medicine, environmental health, social work and public health students. PSYC5040 uses community-based participatory research methodology and theory relevant to health sciences and rural settings.
Our recently implemented PhD program concentration in experimental psychology has a translational focus and also promotes inter-professional contact via coursework and research. Further, a core component of the experimental concentration is a seminar course on the Psychology of Diversity (PSYC7770) which covers various theoretical topics, such as racial identity development, stigma and identity, social contact to effect change in attitudes, among others – all in the context of psychological science and understanding the experiences of individuals differing on a variety of dimensions, including gender, race/ethnicity, sexual orientation, social status, and immigration status. This course serves as a guided elective for clinical students. Further, we strive to ensure cross fertilization between the clinical and experimental programs. For one thing, students in both concentrations recruit faculty from both concentrations to serve on their graduate advisory committees. Further, the experimental faculty provides support to the clinical program by identifying and ensuring the achievement of learning outcomes appropriate to the broad and general foundations training expected of clinical students.
In their clinical training, students address how diversity issues are relevant to their cases. Indeed, one of the major components of the clinical capstone project is the section on how diversity issues are relevant to the case being described. This application is designed to help prepare students to work with diverse populations, such as they will find in both the Behavioral Health and Wellness clinic and their externship placements. In addition to racial and ethnic diversity, the BHWC caseload includes diverse individuals. Of the 143 visiting the clinic in the last year (as of 2011), 51 (35%) were female and 2( 1%) were transgender. In addition, of the 74 clients who provided ethnic data, 65 were Caucasian, while 3 (4%) were African American, 3 (4%) were Latino, 1 (1%) was Asian, 1 (1%) was Romanian/German, and 1 (1%) was German/Somoan. Further, students are exposed to clients with diverse religious values, and therefore religion and spirituality issues are dealt with in therapy. We also have several clients with physical disabilities seeking treatment in the BHWC. Through their experience working in the department's BHWC as well as a host of externship placements, students are exposed to a diverse range of client demographics, clinical settings, and colleagues. Students are also exposed to a diverse range of presenting problems, from long-term schizophrenia to adjustment disorders. Community mental health locations offer students the opportunity to work with individuals of varying levels of SES. For example, at the Downtown Clinic, which is a nurse practitioner-run clinic for low-income individuals, students gain experience handling issues related to low SES and homelessness. Another unique feature of the Downtown Clinic is that Johnson City's Hispanic and migrant population is disproportionately represented, thus exposing students to ethnic diversity and the reality of the language barrier. Moreover, students working within primary care settings collaborate with physicians and residents of varying racial, ethnic, and foreign national backgrounds (e.g., Pakistani, Indian).
Our clinic director, Dr. Kerry Holland, is very active in the community with regard to promoting diversity issues. She has provided diversity training for medical students at Quillen College of Medicine, and started a chapter of Parents, Families, & Friends of Lesbians and Gays (PFLAG) in Upper East Tennessee. Her efforts are notable because our region leans toward extreme political and religious conservatism, which has created a difficult and challenging environment for individuals from sexually diverse backgrounds. In addition to student training, the department fosters faculty diversity education. A number of faculty (e.g., Drs. Brown, Cantrell, Dixon, Ellis) have received Safe Zone Training, and Dr. Stacey Williams is now co-leading the annual university-wide training for faculty, staff, and students.
Dr. Holland, along with an advanced graduate student, has recently created an intake training video that highlights examples of the complexities that can arise with a clinical intake. The role-play video depicts a client who mentions both a partner and a husband when describing her relationship history. The video is intended to assist students in developing respectful and effective skills to handle complex intake encounters.
Climate of Respect
Our formal and informal efforts to promote diversity contribute to a climate in which diversity is celebrated. To further promote a climate of respect, we provide activities in the department and support activities in the larger university and community related to diversity. One effort in this regard is the infusion of diversity into our speaker series. We reserve one speaker series event per year to a topic related to diversity, but in reality, many of our speakers have addressed diversity issues. In Spring semester, 2011 we had Dr. Naomi Hall, who represented cultural diversity in her personal characteristics as well as her research on ethnic minority risk for HIV and promotion of sexual negotiation skills. We also have organized university-wide events that reflect diversity, such as Jean Kilbourne (who spoke about women and advertising) and Tim Wise (anti-racist writer and activist co-sponsored by the ETSU Race Relations Dialogue Task Force). Ideas we have for moving forward with this effort include hosting a university-wide event on men's experience of sexual abuse – a topic that is rarely discussed and that goes against societal expectations of gender, and collaborating with the university's Office of Multicultural Affairs in their numerous efforts to increase the depth of diversity consciousness on campus. We believe that our faculty and students' current affiliations also could facilitate our efforts to sponsor, co-sponsor, and support larger scale diversity relevant events (for instance: Dr. Chris Dula is a member of the ETSU Race Relations Dialogue Task Force; Drs Peggy Cantrell and Stacey Williams are member of women's studies faculty/steering committee; Dr. Jamie Hirsch founded the campus group Active Minds which focuses on raising awareness about mental health and seeking care; Dr. Stacey Williams has been part of leadership of the PFLAG chapter; and numerous undergraduate and graduate students (e.g., David Hutsell) are members of organizations promoting respect for diversity (such as NAMI and LGBTies).
The department encourages faculty and student research that promotes an understanding of diverse perspectives. Our current faculty represents quite a range of areas of psychology, as well as specific research areas within each. Some faculty and student research activities explicitly focus on individual differences, whereas others examine the extent to which individual differences are contributors to mental and behavioral health outcomes. Drs. William Dalton III and Jodi Polaha conduct research directly relevant for rural Appalachia and both mental and physical health. Dr. Wallace Dixon studies individual differences in linguistic, cognitive, and temperament development.
Finally, we have recently undertaken systematic and continuous assessment of diversity-related activities in the department. Through this effort, we are collecting information on the current activities in which students and faculty participate that relate to diversity. In addition to tracking our progress in the area of diversity, we will use the information gathered to assist in updating the department website and newsletter. Moreover, gathering and posting such information will contribute to the recruitment and retention of diverse staff and students, as well as to a climate of respect.
The findings from our initial survey of faculty revealed faculty members are studying an array of topics related to diversity including:
Older adults, rurality, and race/ethnicity as pertaining to psychopathology, personality, and health functioningAttitudes about sexual orientation and stigmaDiversity in higher education at universities and community colleges in TennesseeTraumatic events and discrimination experiences among South AfricansReligiosity in relation to stress and healthHow gender and socioeconomic status moderate trauma experiences and psychosocial functioningWomen's infertility experiences in AppalachiaPsychological make-up and well-being of various minority groups (e.g., LGBTQ)Cultural norms between social groups/regionsRural Appalachian families and childrenRural, African American, and Hispanic populations
Related, all faculty who completed the survey in 2011 (N=12) felt somewhat or often supported by the department in terms of their own diverse characteristics (M=3.33, possible range 1-4). Further, many faculty members (9 out of 12) infuse diversity into their training of graduate students at least sometimes or often.
Findings from the faculty survey were further supported by those of a similar diversity survey completed by the current graduate students in the clinical psychology program (N=22). The majority of students indicated feeling supported "somewhat" or "a lot" by peers (85%) and the Clinical program (95%) for their individual differences or personal demographics. Sample comments regarding the program include:
"The program and faculty do an excellent job of supporting diversity as well as encouraging self-exploration into one's individuality."
"The program ensures a safe & accepting environment for students."
"I have never felt discriminated against by the program by any differences I may have from faculty or other students."
"Professors are generally supportive in most areas, including those related to diversity."
"The clinical faculty are open-minded and supportive."
"The program seems to be open to a wide breadth of experiences, beliefs, and differences so long as one is capable of being open to differences and diversity in others, specifically our clients."
Further, the majority of clinical students reported having taken at least one course or had training experience pertaining to diversity (82%) so far in their training. Those who commented on their experiences with coursework in the department reported widespread inclusion and helpfulness:
"We had a seminar course dedicated to understanding how issues of diversity factor into psychological studies and psychological health. The reading and conversations were helpful in increasing mindfulness about diversity-related issues. Many (I would say most) other classes incorporated issues of diversity into the discussions and reading material. Ethics class (w/Dr. Ellis) was very helpful in attuning our minds to the various types of issues that people may present with in clinical work. Assessment courses spent time discussing how diversity among clients may impact assessment scores. Clinically focused courses always incorporated readings and discussions of how clinicians must maintain awareness of diversity-related issues. The anthropology course was unique and helpful in its focus on cultural and socioeconomic diversity."
"Although diversity training is weaved throughout courses, the social psychology seminar was particularly helpful in increasing my understanding of privilege and challenges associated with coming from a less privileged background."
"Social Diversity- discussed issues relating to inequality among races, as well as protective and risk factors for different races. Cultural Anthropological Studies- Discussed culture bound syndromes. In addition I learned a lot from a guest speaker we had who was a Mexican adjunct professor at a local college who came and spoke to our class about her work, about curanderismo, but mainly her culture. Not only was it extremely interesting it was also very easy to understand and I still remember a lot she told us about cultural differences."
"Legal and Ethical Issues in Psychology provided a nice introduction to cultural competence. As well, Personality and Treatment models included a portion on multicultural practice. From these classes, I feel I know the bare basics about cultural competence, how to become more culturally competent, and possible courses of action for when I encounter a client who belongs to a culture I am unfamiliar with."
Of those who completed the survey, although students indicated their race/ethnicity as White, there was variation in other areas of diversity. Specifically, current reports indicated 74% of clinical students are female while 26% are male, 91% are of heterosexual orientation while 9% are of minority sexual orientation (gay, lesbian, or bisexual), and 39% are married while another 48% are either in a committed relationship and/or cohabitating. In addition, while 53% report being Christian, among the others, 26% report being spiritual but not religious and 16% are atheist. Students also reported an age range from 23-49. And, the majority of current students indicated having grown up in the South (68%), 18% originated on the East Coast of the U.S. and the remainder were from the North, Northwest, Midwest, or Southwest.
As depicted in the findings of the surveys, as well as the content of this document overall, the Clinical program has made many successful strides in the area of diversity. In particular, we have integrated a diversity focus in the areas of recruitment and retention and in the education of students. And in so doing, we believe we have created a climate of tolerance and acceptance.
Rankin, S., & Reason, R. (2008). Transformational Tapestry Model: A comprehensive approach to transforming campus climate. Journal of Diversity in Higher Education, 1, 262-274.
Wilson, J. L., & Meyer, K. A. (2009). Higher education websites: The "virtual face" of diversity. Journal of Diversity in Higher Education, 2, 91-102.