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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 identity, sexual orientation, religious orientation, religion, disability status, socioeconomic status, and national origin (and the intersection of these multiple identities). 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 16 full-time faculty – 9 men and 7 women – with two additional clinical hires anticipated for fall 2018. Open faculty positions are advertised in both a general audience publication (i.e., the APA Monitor), an African-American targeted publication (Psych Discourse), and an Hispanic targeted publication (Journal of Latina/o Psychology). 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 (https://www.etsu.edu/equity). The Office of Equity and Diversity oversees equity standards and university-wide education and training on diversity, and requires diverse members on all faculty search committees. All ads for tenure track faculty 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 including the Council of Graduate Departments of Psychology (COGDOP), the Council of University Directors of Clinical Psychology (CUDCP), the Society for Personality and Social Psychology (APA Division 8), the Cognitive Development Society, and Psychology of Sexual Orientation and Gender Diversity (APA Division 44).
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 McNair programs. The program also utilizes a recruiter funded by the School of Graduate Studies who attends graduate school and career fairs at institutions that identify as serving historically underserved groups. The program individually corresponds with all contacts identified through this institutional recruitment. In addition, with each cohort of potential students we recruit doctoral students who demonstrate sensitivity to diversity issues particularly as they relate to a clinical setting. When we make offers of admission, our admissions letter includes a statement affirming the program’s commitment to training students to work with clients who exhibit many facets of diversity and individual differences.
Among our efforts to promote retention of diverse faculty, and which also serve as additional recruitment strategies, has been our restructuring of the departmental website to highlight department-wide diversity efforts. According to research published in the Journal of Diversity in Higher Education (Wilson & Meyer, 2009), program websites have been referred to as their virtual face, and may be critical in establishing a departmental identity especially useful for minority faculty and students who are considering their level of belongingness in particular programs. Via the website, individuals can evaluate whether the program prioritizes their diverse needs and interests. Our website includes 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 professional activities (presentations, publications, projects). For example, Dr. Chris Dula, has served as Co-Chair of the ETSU Presidential Task Force on Diversity. In addition, Dr. Stacey Williams, who is also a member of that task force, has recently received an NIMH grant to implement a coping intervention for minority stress, and has been selected to participate in APA’s Leadership Institute for Women in Psychology.
In addition to the above retention efforts (e.g., diversity representation on the departmental website), which may apply to student retention as well, we have initiated specific strategies to retain diverse students. For example, we give an annual Priester-Sloan award (among other awards), which is a graduate student scholarship for first year graduate students based, in large part, on financial need. The award recognizes the struggles of students based on economic circumstance. In addition, we infuse diversity into our speaker series as well as courses within our department. Many of our speakers address individual and cultural diversity issues, while all of them represent diverse topics within psychology. And, faculty routinely infuse diversity-related content into their undergraduate and graduate level courses.
Other efforts to enhance both recruitment and retention of diverse faculty and students include departmental monthly brownbags, a new departmental organization, and service opportunities for graduate students. The brownbags provide opportunity to connect with other faculty and students and gain mentoring through both peer and faculty feedback. Department students and faculty have collaborated to start a new student-faculty organization (PEACE, or “Psychologists for Equity, Awareness, and Community Enhancement”), focused on social justice and enhancing the belongingness of diverse faculty and students. And graduate students participate in faculty meetings to ensure they have a voice within the department and simultaneously provide them with service opportunity.
Finally, of course, our efforts to promote diversity in our training curriculum and in the environments and climates we establish also promote retention of diverse faculty and students.
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 multiple courses: Ethics
(PSYC5100), Psychopathology (PSYC5825), Personality & Psychotherapy Models (PSYC5220),
Assessment I & II (PSYC5830 & PSYC5850), Evidence-Based Interventions (PSYC6870),
and Rural Case-Oriented Interventions (PSYC6600). Students also cross-train with other
diverse disciplines in the Clinical Interviewing Course (PSYC5870).
Further, both clinical and experimental students take either Cultural Anthropological Applications to Rural Practice (PSYC7500), which focuses on mental health in rural Appalachia, or Diversity in Psychological Science (PSYC7770), which focuses on rural Appalachia as well as broader areas of diversity (e.g., racial identity, socioeconomic status, LGBT identity) and intersections of identity.
Students also are presented with elective course opportunities that when taken provide further nuanced training and outreach to specific diverse groups. For instance, Dr. Jason Steadman teaches a graduate elective course on cultural competence in clinical psychology, and Dr. Stacey Williams teaches an elective course in the psychology of sexual orientation and gender diversity.
Further, we strive to ensure cross fertilization between the clinical and experimental programs. Students in both concentrations recruit faculty from both concentrations to serve on their graduate advisory committees. In addition, the experimental faculty provide support to the clinical program by teaching all modules in the discipline specific knowledge course (Broad and General Psychology, PSYC5000).
In their clinical training, students address how diversity issues are relevant to each of 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 and articulate the role of individual differences in case conceptualization and treatment, such as they will find in both the Behavioral Health and Wellness clinic and their externship placements. With respect to the BHWC, of the 2221 clinic hours, diversity was represented in the following ways:
Adults - 66%
Adolescents - 12%
Children - 20%
Couples/families - 2%
Caucasian - 90%
African-American - 3%
Hispanic - 3%
Asian - <1%
Multiracial - 3%
International - <1%
Heterosexual - 64%
Gay/lesbian - 7%
Bisexual - 1%
Pansexual - 2%
(The remaining are unsure, largely due to child clients.)
Physical disability - 8%
Blind/visually impaired - 1%
Deaf/hard of hearing - 1%
Cognitive/learning disability - 12%
Developmental disability/autism - 11%
Serious mental illness - 16%
Male - 44%
Female - 54%
Transgender - 2%
Further, students in the BHWC 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. Students
are also exposed to a diverse range of presenting problems, from long-term schizophrenia
to adjustment disorders. Externships offer students the opportunity to work with diverse
individuals in our local region. This includes persons disproportionately impacted
by poverty and resource deprivation, and students are directly immersed in rural culture.
Specialized placements also promote work with a range of client populations, including
those who are homeless, involved with the criminal justice system, involved with the
foster care system, or low-income with few healthcare resources. Moreover, students
working within primary care settings collaborate with physicians and residents of
varying racial, ethnic, and foreign national backgrounds (e.g., Pakistani, Indian)
and are exposed to diversity in training and disciplinary practices.
Students complete the following annual trainings specific to diversity and sensitivity to working with diverse colleagues:
- Preventing discrimination & sexual violence: Title IX, VAWA, & the Clery Act for faculty & staff
- Respect and inclusion series: The power of respectful language
- Respect and inclusion series: Transition to respect
- Respect and inclusion series: Uncovering implicit bias
Students receive interprofessional didactic training in their first-year clinical interviewing course as well as later courses that emphasize rural culture. Students and faculty from other disciplines at ETSU who participate in these interprofessional courses come from the Colleges of Medicine, Nursing, Pharmacy, and Public Health. Students are also provided the option of participating in an extracurricular program sponsored by the Interprofessional Research and Education Council at ETSU that results in an interprofessional training certificate.
Students work with an array of clinical professionals from differing backgrounds on
their Clerkship and Externship placements, and because of the program’s focus on rural
mental health care in the context of integrated primary care, students participate
in team-based care on their clinical placements. This results in students learning
to voice their identities as clinical psychology students and understand their own
as well as others’ roles on an integrated health care team.
Students provide clinical services and receive clinical training in many different area mental health and integrated primary care practices, where they work with clients of all ages and with a range of unique clinical needs.
Our clinic director, Dr. Kerry Holland, serves as a role model for the engagement of diversity in professional practice, and 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 in 2008 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 that identify as sexual minorities. In addition to student training, the department fosters faculty diversity education. Our faculty are regularly receiving Safe Zone Training, and Dr. Stacey Williams is co-leading, and Dr. Kerry Holland is facilitating, the university-wide training for faculty, staff, and students. With recent increases in safe zone trainings on campus, we anticipate all of our faculty members will participate.
The clinic routinely updates training videos to reflect current best practice and inclusion of diversity and individual differences. For example, Dr. Holland, along with an advanced graduate student, has created an intake training video that highlights examples of the complexities that can arise with a clinical intake. The video is intended to assist students in developing respectful and effective skills to handle complex intake encounters. And, Dr. Steadman is a bilingual clinician. He translates clinical materials for use with the Spanish community in the BHWC.
Climate of Respect
Our collective efforts to promote diversity contribute to a thriving 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. Many of our speakers have addressed individual and cultural diversity issues, while all of them represent diverse topics within psychology. In Fall of 2016 the department co-sponsored a Multicultural Center event which brought to campus a spoken word artist on diversity, Andrea Gibson. In the future, we anticipate planning a university-wide event on intersectionality, underscoring the importance of multiple identities simultaneously. Indeed, intersectionality is a topic that is gaining traction in diversity science that is a vehicle for improving understanding among students and faculty alike of privilege and prejudice, as well as people’s experiences in the world more generally. Our faculty and students' campus connectedness also facilitates our efforts to sponsor, co-sponsor, and otherwise promote larger scale diversity relevant events. For example, psychology faculty have been co-chair or members of the presidential diversity task force, and therefore leading campus-wide efforts to educate on topics of diversity; and numerous psychology graduate and undergraduate students are active members of organizations promoting respect for diversity (e.g., HEROES, TWLOHA).
The department encourages faculty and student research and activities that promote 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. Dr. Allie Hock studies the development of social cognition during the first year of life, and compares visual-cognitive functioning in non-drug exposed and opioid-exposed infants. Dr. Andrea Clements was awarded a $119,000 grant from the State of Tennessee Department of Children’s Services to investigate the impact of implementing trauma informed care throughout the Boys & Girls Club of Johnson City/Washington County. And, Dr. Jameson Hirsch examines resilience and physical and mental health, having recently completed a project on the LGBTQ population and the impact of the recent presidential election.
Our faculty are active in service-related work both on campus and within the profession that allows them to support diverse groups and disseminate their expertise. For example, Dr. Jason Steadman provides trainings in the local community on clinical services to immigrants. Dr. Andrea Clements is faculty advisor to two religious student organizations on campus. Dr. Jill Stinson is a member of the IRB on which she serves as a reviewer for research on vulnerable populations. Dr. Stacey Williams is part of the APA’s Leadership Institute for Women in Psychology.
To this end, the department has started a student-faculty organization based on the initiative of a graduate student in clinical psychology. A committee consisting of clinical and experimental psychology faculty and students (both graduate and undergraduate) met in the Spring of 2017 and established the new group, calling it PEACE, or “Psychologists for Equity, Awareness, and Community Enhancement”. The group will bring together faculty and students in psychology at ETSU to move forward the department’s diversity agenda, support diverse students, and participate in community social justice projects. Drs. Williams, Steadman, Dodd, and Morelan are faculty members involved in the development of PEACE with the support of department chair, Dr. Dixon, and the entire faculty.
Finally, we systematically and continuously assess diversity-related activities in the department. Through this effort, we collect information on student and faculty engagement in diversity-related activities, which we use to inform the department website and annual newsletter. As noted above, gathering and disseminating such information contributes to the recruitment and retention of diverse staff and students, and to a climate of respect.
The findings from our recent 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 functioning, stigma and minority stress as they relate to social support and health disparities, diversity in higher education at universities and community colleges in Tennessee, religiosity in relation to stress and health, women's infertility experiences in Appalachia, cultural norms and stigma of parents seeking mental health for their children in rural regions, adverse childhood experiences and mental health outcomes and the moderating role of diversity factors (race, rurality, SES, gender identity, sexual orientation, religious identification) on psychological outcomes.
Notably, faculty who completed the 2017 survey felt supported by the department in terms of their own diverse characteristics. Further, faculty members infuse diversity into their training of graduate students at least sometimes or often. In our future efforts we intend to initiate discussions during faculty meetings to provide ideas and support for continued and increased diversity infusion.
In a parallel diversity survey, student responses echoed those of faculty. The majority of students indicated feeling supported "somewhat" or "a lot" by peers (15 out of 17) and by the clinical program (14 out of 17) for their individual differences or personal demographics. Sample comments regarding the program include:
- "Again, I feel that staff and faculty have been overwhelmingly supportive of me, my academic success, and my research interests.”
- “I feel that I am very supported by the clinical program.”
- “I have had positive experiences by the faculty in the department and feel comfortable
bringing up any concerns I have related to my personal demographics.”
Students who commented on their diversity experiences in formal coursework indicated a widespread feeling of inclusion and helpfulness, even in courses not inherently diversity specific:
- “The most broad and relevant course for my understanding of diversity was the Diversity in Psychological Science course. The class went beyond the typical race and sex topics of diversity and really allowed for a more thorough understanding of intersectionality and diversity from other perspectives (sexual orientation, age, SES, religion/spirituality, rurality). The tie into clinical application was also useful. Other courses that emphasized diversity include the Rural Case Oriented Learning course, which helped in our understanding of rurality related to health. Ethics was also focused on diversity related to age, race, and sex. All courses have incorporated some form of diversity, but typically in just one class meeting."
- “The diversity course with Dr. Williams. This course was the most in-depth course
I have had in the program and the most beneficial.”
The outcomes of our efforts to recruit and retain diverse students indicate diversity along a broad array of dimensions. Of those who completed the survey, the majority of students indicated their race/ethnicity as White (16 out of 18), while one student identified as African American and one as Asian. Approximately 65% of clinical students identified as female with the remainder identifying as male. Eighty-nine percent identified with a heterosexual orientation, and 11% with a minority sexual orientation (gay or bisexual). Seventeen percent reported being married, with another 55% reporting being in a committed relationship and/or cohabitating. In addition, while 50% reported being religious (Christian and non-Christian), 28% reported being spiritual but not religious, and 23% reported being atheist or not religious/spiritual. Students also reported an age range of 22-35 years. And, while many of our current students indicated having grown up in the South (47%), 24% originated on the East Coast of the U.S., with the remainder hailing from the North, Northwest, Midwest, or Southwest.
Our student cohort characteristics since our last accreditation period demonstrate our ability to recruit students diverse in other ways as well: 12% (n = 3) are non-traditional students entering graduate school after varying periods in other career fields, 4% (n = 1) is a McNair scholar, 8% (n = 2) are first-generation Americans, and at least 36% (n = 9) originate from very rural locales. In addition to this, many of our students are the first in their families to attend graduate school, and some are the first from their families to receive any education post-high school.
As depicted in the findings of the surveys, as well as the content of this document overall, the Clinical program prioritizes diversity as a core training element and philosophical principle. We have maintained a focus on diversity in the areas of recruitment and retention of faculty and students, and in the education of students. We recognize that the degree of diversity and intersectionality of diverse identities creates a rich learning experience for our students. And we value and cultivate a climate of acceptance and respect.
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.