Developing the IDCaRe team: an integrated and culturally-affirming approach to improving health engagement for HIV-positive veterans.

BACKGROUND: Veterans Health Administration (VHA) has been at the forefront of offering integrated and patient-centered care to address the complex needs of more than 30,000 Veterans with HIV in the United States of America. These Veterans present with diverse cultural identities, personal values, and goals pertinent to their care, and they are often managing multiple comorbid chronic conditions, mental health diagnoses, and psychosocial stressors alongside HIV. The quality of their care has often been affected by stigma, minority stress, and the quality of the patient-provider relationship and associated collaborations over treatment approaches and goals, which has a direct effect on outcomes. OBJECTIVE: At San Francisco VA Health Care System, the Infectious Disease Care and Resilience (IDCaRe) team was established to improve outcomes for Veterans with acute needs or persistent difficulties in care delivery and efficacy. METHOD: A five-step model to address complex needs in HIV care was adapted from existing literature and evidence base, combined with a culturally-aligned, interdisciplinary care orientation. This model was implemented with patients determined to be at high-risk for poor health engagement. A representative composite case study demonstrates the process. RESULTS: Three Veterans underwent the intervention with results presented. Lessons learned and future discussions are also discussed. CONCLUSION: The IDCaRe model has promise as an integrated, patient-centered, behaviorally-grounded intervention for improving HIV-related care outcomes for Veterans with complex needs.

Cultural humility training interventions for healthcare students to improve care for gender and sexual minority groups: Protocol for a systematic review and a proposed meta-analysis.

Introduction: To deliver comprehensive and efficient care, it is crucial to understand and address the unique healthcare needs of gender and sexual minority (GSM) groups. Implementing cultural humility training may enhance healthcare students' sensitivity, awareness, and proficiency in serving patients. However, there's a necessity to thoroughly evaluate the impact and effectiveness of these interventions, especially in relation to addressing the distinct healthcare requirements of GSM groups. This protocol describes the steps in conducting a systematic review (SR) to investigate if cultural humility training interventions for medical students enhance care of GSM groups. This SR aims to guide the creation of focused interventions and instructional plans to support fair healthcare delivery for GSM populations. Methods and Analysis: The objective of this SR encompass a comprehensive examination across multiple databases such as PubMed (NCBI), Scopus (Elsevier), Cochrane (Wiley), Web of Science (Clarivate). Using keywords and MeSH phrases, the search method will find relevant research from each database's launch from January 1, 2000, until August 30, 2024, emphasizing English-language publications. To ensure comprehensiveness, reference lists of qualifying papers will be thoroughly reviewed. We shall extract the data and use the appropriate Joanna Briggs Institute (JBI) checklist to evaluate the quality of the included study. By synthesizing the data, the findings will illuminate the value and efficacy of cultural humility training interventions for medical students in enhancing GSM group care. This synthesis will incorporate quantitative studies, to ensure a comprehensive understanding of the interventions' impacts. Ethics and dissemination: Ethics approval is not sought as the review will only synthesize data from published studies. The findings will be presented at conferences and published in peer-reviewed journals. PROSPERO registration number: CRD42024533825 Strengths and limitations of this study:•Our study examines cultural humility training, emphasizing self-reflection and power dynamics, specifically relevant for gender and sexual minority (GSM) groups.•We focus on healthcare students, exploring how early cultural humility training can impact future practice and GSM care.•This is the first systematic review and meta-analysis of cultural humility training for GSM groups, addressing a gap in existing literature.•Our findings aim to inform curriculum and educational policies, addressing a significant need in medical training.•Limiting the review to English-language studies may exclude important research conducted in other languages, potentially missing valuable perspectives and findings that could enhance the understanding of cultural humility training's global applicability.•The review may face challenges in measuring the long-term impact of cultural humility training interventions on healthcare students' competency and attitudes, as existing studies might have a limited follow-up period.

Insights gained through exploring UK midwifery care by US midwifery graduate students in a short-term study abroad: A qualitative study.

INTRODUCTION: Student midwives exposed to effective systems of midwifery care in other countries can consider how aspects of this knowledge can translate into their healthcare system to improve maternal and infant perinatal outcomes. An optional short-term study abroad (STSA) experience was developed for US midwifery graduate students to expose them to the UK healthcare system, where midwives are considered the primary professionals for the care of the childbearing family. This qualitative study explored the influence of an STSA experience on US midwifery graduate students' learning of midwifery in the UK. METHODS: Ten midwife student participants wrote pre- and post-trip narratives in the US and daily diary entries during their week in the UK. A grounded theory approach guided the content analysis. The themes were derived from the NVivo software data by three midwife researchers who value global health learning experiences. Analysis was shared with participants to ensure its trustworthiness. RESULTS: Themes that emerged included: 'Another viewpoint', encapsulating curiosity and comparison of US and UK midwifery; 'Eye-opening', capturing surprise at noted differences between US and UK midwifery practice; and 'Goals met and influenced', expressing how their learning is anticipated to shape their professional identities and career trajectories going forward. CONCLUSIONS: US student midwives exposed to functional systems in countries where midwifery care is fully integrated, broadened their views of midwifery care and practice. They became inspired to make positive changes in the US. Educational opportunities for midwifery students, such as STSA experiences, can positively influence self-confidence and professional identity.

Truth to Action: Lived Experiences of Indigenous Healthcare Professionals Redressing Indigenous-Specific Racism.

STUDY BACKGROUND: The experience of discrimination through stereotyping, profiling, and bias-informed care not only leads to poor access to healthcare services, but low retention rates of Indigenous health professionals (IHP). As health systems transformation evolves, a significant gap remains in supporting IHP to safely address racism, to be supported culturally to bring their authentic selves and voices to work, and to attend to one's own intellectual, physical, relational, cultural and spiritual wellness within a westernized model of care. PURPOSE: The aim of the study was to investigate the experiences of IHP working in mainstream healthcare in order to understand how their work environment impacts the delivery of cultural safe practices. What is reported in this manuscript, as an exercise in truth-telling, is findings about lived experiences of IHP working in one mainstream provincial healthcare region, and not the whole context and outcomes of the study. METHODS: Using Indigenous research methodologies, we embodied our Indigeneity into every facet of the research process. We facilitated three talking circles with participants grounded in a distinct cultural and ceremonial context following Secwepemc protocols. RESULTS: The collective voices of IHP revealed the following common experiences: confronting genocide; addressing Indigenous-specific racism; uprooting toxicity and inequities; and upholding Indigenous human rights while enhancing accountability of systems transformation. CONCLUSIONS: The experience of IHP working in health systems goes beyond mere individual employment obligations, its often about a families and communities advocacy for Indigenous rights, culturally safe working environments and access to dignified and respectful healthcare service. This study highlights the need for IHP to be actively involved in health system transformation to ensure the redesigning and restructuring of healthcare service delivery by and for Indigenous Peoples remains centered on Indigenous health and human rights.

Exploring the implicit meanings of 'cultural diversity': a critical conceptual analysis of commonly used approaches in medical education.

Existing approaches to cultural diversity in medical education may be implicitly based on different conceptualisations of culture. Research has demonstrated that such interpretations matter to practices and people concerned. We therefore sought to identify the different conceptualisations espoused by these approaches and investigated their implications for education. We critically reviewed 52 articles from eight top medical education journals and subjected these to a conceptual analysis. Via open coding, we looked for references to approaches, their objectives, implicit notions of culture, and to implementation practices. We iteratively developed themes from the collected findings. We identified several approaches to cultural diversity teaching that used four different ways to conceptualise cultural diversity: culture as 'fixed patient characteristic', as 'multiple fixed characteristics', as 'dynamic outcome impacting social interactions', and as 'power dynamics'. We discussed the assumptions underlying these different notions, and reflected upon limitations and implications for educational practice. The notion of 'cultural diversity' challenges learners' communication skills, touches upon inherent inequalities and impacts how the field constructs knowledge. This study adds insights into how inherent inequalities in biomedical knowledge construction are rooted in methodological, ontological, and epistemological principles. Although these insights carry laborious implications for educational implementation, educators can learn from first initiatives, such as: standardly include information on patients' multiple identities and lived experiences in case descriptions, stimulate more reflection on teachers' and students' own values and hierarchical position, acknowledge Western epistemological hegemony, explicitly include literature from diverse sources, and monitor diversity-integrated topics in the curriculum.

Clinical Psychology Graduate Programs: Falling Short in Cultural Humility Training.

Despite requirements by the American Psychological Association and the Psychological Clinical Science Accreditation System regarding training and education in cultural humility, questions remain regarding the presence and quality of the training in clinical psychology PhD and PsyD programs. This is a critical issue as inadequate training in diversity, cultural humility, and multiculturalism has substantial downstream effects on care for clients of color and may contribute to racial disparities and inequities in access to mental health services. We seek to explicitly evaluate key features of the conceptual model thought to improve the provision of mental health services for clients facing oppression and marginalization which includes perceptions of clinical psychology graduate programs' training in and assessment of cultural humility. We also assess self-efficacy related to the application of cultural humility as well as actual practice of actions associated with cultural humility. Each of these domains are evaluated among a sample of 300 graduate students and faculty, clinical supervisors, and/or directors of clinical training (DCTs) and differences across position and race of participants were tested. Study findings highlight significant gaps between what trainees need to develop cultural humility and what they may actually be receiving from their respective programs. While findings suggest that there is still a lot of work to be done, understanding the state of the field with regards to clinical training in cultural humility is an important first step towards change.

Mixed Methods Study Investigating Adolescent Acceptance and Implementation Outcomes of Serving Spicy Vegetables in School Lunch.

Background: Only a few adolescents are meeting their daily vegetable requirement. At the same time, spicy food is increasingly popular and familiar across cultures. Objectives: To explore the implementation of spicy vegetables into school meals, the primary objective is to determine adolescents' preferred degree of hot spice on steamed broccoli. Secondary objectives include estimating the appropriateness and acceptability of spicy vegetables in the National School Lunch Program and identifying strategies to promote spicy vegetables within school meals. Methods: One hundred participants between the age 11 and 17 y sampled 4 steamed broccoli florets with varying levels of a ground red and cayenne pepper spice blend (0, 0.9, 2.0, and 4.0 g). Participants rated their likeability of each broccoli sample on a 9-point hedonic scale and answered a survey assessing chili liking, chili consumption patterns, appropriateness, and acceptability. An interview assessed perspectives on spicy vegetables within school lunch.Regression analyses assessed relationships between participant attributes and sample ratings and survey outcomes. Agglomerative hierarchical cluster analysis was conducted to cluster together participants with similar sample liking ratings. Results: Seventy-seven percent of participants reported that chili pepper makes food taste better, and 67% consumed spicy food weekly or daily. Chili likers (n = 41) were the dominant cluster group, compared with moderates (n = 31) and chili dislikers (n = 28). Thematic analysis results suggested that most participants support incorporating spicy vegetables into school lunch but mushy vegetable texture may undermine the impact of changing school vegetable spice levels. Conclusions: Spicy foods are commonly consumed by adolescents, and these findings support the inclusion of spicy vegetables in school lunch. Additional research is needed to identify policies and practices to improve the texture of vegetables in school meals and determine additional strategies to support cultural humility in child nutrition programs.

Incorporating equity, diversity and inclusion (EDI) into the education and assessment of professionalism for healthcare professionals and trainees: a scoping review.

BACKGROUND: Current definitions of professionalism for healthcare trainees often lack equity, diversity and inclusion (EDI) in the expectations and assessment of professionalism. While professionalism teaching is incorporated in healthcare training, equity-deserving groups still experience discrimination. This scoping review investigates the literature to understand how EDI and associated domains of cultural humility, and advocacy can be incorporated in healthcare trainees' education and assessment of professionalism. METHODS: The Arksey and O'Malley framework was applied to this scoping review. MEDLINE, Embase & PsychINFO were searched up to March 2023, with terms surrounding health professionals, professionalism, EDI, cultural humility, and advocacy. Titles and abstracts (n = 3870) and full-texts (n = 140) were independently screened by two reviewers. Articles were included if they focused on EDI, cultural humility, or advocacy among healthcare students/trainees, and had outcomes related to professionalism. Articles lacking discussion of professionalism as an outcome were excluded. Themes were generated by mutual discussion. Risk of bias was assessed using the Cote et al. and Medical Education Research Study Quality Instrument (MERSQI) tools. RESULTS: 48 articles underwent thematic analysis. Studies investigated the disciplines of medicine, nursing, social work, physiotherapy, and dentistry. Most studies were qualitative in methodology (n = 23). Three themes emerged: (1) EDI-related interventions are associated with improved professionalism of healthcare trainees/workers (n = 21). Interventions employed were either an EDI-associated educational course (n = 8) or an exchange program to promote EDI competencies among trainees (n = 13). (2) Trainee definitions and perceptions of professionalism include themes related to EDI and cultural humility (n = 12). (3) Current standards of professionalism are perceived as non-inclusive towards historically-marginalized populations (n = 15). Literature investigating advocacy as it relates to professionalism is limited. CONCLUSION: This review identified that core EDI principles and its associated domains of cultural humility and advocacy are often viewed as integral to professionalism. These findings create a strong impetus to incorporate EDI principles within professionalism frameworks in healthcare education. Future research should employ standardized tools for professionalism assessment to provide more conclusive evidence. Incorporating patient perspectives of professionalism can inform actionable recommendations for fostering inclusive healthcare environments.

Informing Culturally Safe Advance Care Planning: An Interpretive Descriptive Study of Internationally Educated Nurses in Ontario.

BACKGROUND: Maintaining cultural safety during advance care planning (ACP) discussions is an essential component of holistic care provision. Most nurses feel unprepared to engage in ACP and the current literature offers limited recommendations on how nurses can lead culturally safe ACP discussions. Internationally educated nurses (IENs) have unique personal and professional experiences to address this gap. PURPOSE: The purpose of this study was to understand IENs' contributions to culturally safe ACP and its implications to nursing practice and ACP policy. METHODS: An interpretive descriptive approach was undertaken. Ten IENs working in Ontario, Canada were individually interviewed using a semi-structured guide to understand their perspectives and experiences of engagement in culturally safe ACP practices. RESULTS: IENs utilized various approaches that were reflected in three actions: practicing cultural humility, utilizing a cautious approach, and empowering clients and families. IENs engaged in intrapersonal and interpersonal cultural humility practices to recognize the unique influence of one's culture on the ACP process. Establishing trust in the nurse-client relationship and cautiously approaching ACP conversations was recognized as important in maintaining cultural safety. IENs also empowered clients by addressing knowledge deficits, misconceptions about ACP, and informing them of their decision-making rights. CONCLUSION: Nurses require education and resources to carry out culturally safe ACP. Education should begin at the undergraduate level and include self-engagement in ACP and cultural humility training. Practicing nurses need ACP training and clear standards/guidelines. There is an opportunity for healthcare organizations and professional/governing nursing bodies to collaborate on developing culturally safe ACP guidelines.

Assessing Cultural, Religious, and Trauma Influences in Human-Animal Interactions for Effective Animal-Assisted Counseling.

The purpose of this manuscript is to enhance the understanding of how racial, social, and cultural factors influence animal-assisted counseling (AAC). As AAC gains popularity, there is an increasing need for clinicians to practice cultural humility and awareness. While AAC has proven beneficial, clinicians must consider the diverse cultural, religious, and trauma-related perceptions of animals. The American Counseling Association (ACA) has established AAC competencies that highlight the importance of understanding these social and cultural factors, assessing past animal-related trauma, and evaluating client suitability for AAC in the United States. Similarly, in 2018, the International Association of Human-Animal Interactions Organizations (IAHAIO) and, in 2024, the Association of Animal-Assisted Intervention Professionals (AAAIP) set standards for competencies related to clients' cultural backgrounds, trauma, and historical oppressions related to certain species. By addressing these considerations, clinicians can better promote and protect the welfare of both clients and therapy animals. While these organizations generally emphasize ethical standards, professional guidelines, and safeguarding client-animal relationships, this manuscript advocates for a more robust examination of cultural, racial, and societal factors in the use of AAC. This includes not only recognizing the ethical implications but also understanding how diverse backgrounds and access disparities shape the effectiveness, acceptability, and accessibility of AAC interventions. This approach integrates culturally responsive practices and promotes a deeper exploration of how race, culture, religion, and societal factors influence human-animal relationships.

Nurturing compassion and cultural humility in health professions students through a brief mindfulness practice.

Objective: Given the importance of compassion and cultural humility in healthcare providers, the study aspired to investigate the effects of a brief mindfulness practice on compassion and cultural humility in health professions students. Methods: A quantitative, one-group pre-test/post-test study was conducted with 58 participants from undergraduate health profession education programs in the United States. Participants completed questionnaires measuring mindfulness, compassion, and cultural humility before and after engaging in an eight-minute loving-kindness meditation exercise three to four times per week for two weeks. Results: There were statistically significant increases in mindfulness, compassion, and cultural humility after participants engaged in the brief loving-kindness meditation exercise, with small to moderate effect sizes. Conclusion: Brief mindfulness practices may be helpful for cultivating essential qualities such as compassion and cultural humility in health professions students. Innovation: The findings add to the research gap about the effects of mindfulness on health professions students' compassion and cultural humility. Using mindfulness as a training tool in health professions education may foster compassion, cultural humility, and mindfulness in health professions students who will become healthcare providers, addressing individual health concerns but also broader social issues related to social justice and health equity.

Pre-post assessment of student application of medication therapy management skills in virtual environments using English and non-English patients.

BACKGROUND AND PURPOSE: A Medication Therapy Management (MTM) encounter allows pharmacists to gather information to make appropriate assessments and recommendations regardless of the patient's language needs and the encounter environment utilized. With the goal of improving comfort and confidence in providing MTM services, working with an interpreter, and providing care in a virtual environment, students participated in a virtual MTM activity with English and non-English speaking patients. EDUCATIONAL ACTIVITY AND SETTING: In groups, students completed two MTM encounters during a virtual skills laboratory. Students were asked to complete a pre- and post-lab survey to gauge their confidence before and after completing these encounters. One encounter was with an English-speaking patient, and one was with a non-English speaking patient which utilized an interpreter for communication. Both encounters were completed using a virtual platform. FINDINGS: As a result of these activities, students reported improved confidence in providing MTM services to a patient who speaks a language different than themselves and managing patients using a virtual platform. Students self-identified that teamwork and pre-encounter preparation were essential for effective MTM services. SUMMARY: Students found completing virtual MTM was a beneficial way to improve comfort and confidence with navigating virtual platforms, gathering medication information, and working with interpreters.

Power failure; an uncomfortable teaching initiative?

BACKGROUND: Introducing medical students to the concept of Cultural Humility, we devised a teaching initiative for students to consider how power manifests through the use of language in clinical communication, with a focus on General Practice. Cultural Humility is a pedagogical framework, introduced by Tervalon and Murray-Garcia, to address what they consider as the limitations of the Cultural Competence model. APPROACH: Our teaching initiative specifically focused on power in clinical communication, both oral consultations and written notes. The session was delivered to third-year medical students during their first 'clinical' year, where they regularly witness and are involved in clinical communication across primary and secondary care placements. Ethical approval was in place to analyse students' reflections on the session. EVALUATION: Students who attended engaged well. They evaluated the session positively as increasing their awareness of the power of clinical language in negatively stereotyping and dehumanising patients. They demonstrated Cultural Humility in their reflections of the unintentional harm of clinical language commonly used for the doctor-patient relationship. However, most striking for us, and where our learning as educators lies, was the low attendance at the session, despite our attempts to underline clinical relevance and importance for development as future doctors. IMPLICATIONS: This article offers a framework for educators interested in Cultural Humility. The implications of this initiative are how (or how not) to develop and deliver training in this space. More consideration is required as educators, including around our own language, as to how to engage students to think around the complex topic of power.

Culturally Diverse Female-Identified Students Discuss Sexual Assault Policies: Dialectics of Safety/Danger.

This article presents dialectical themes that emerged from the grounded theory analysis of 42 focus groups about university sexual assault policies held at four universities in Nova Scotia, Canada. Fourteen cultural communities were represented. Data from female-identified focus groups representing five cultures is deployed to exemplify dialectical themes. When it comes to university sexual assault policies and services, students navigate conflicting needs for disclosure and privacy, justice, and protection. These tensions are intersectionally shaped by gender and culture. Our analysis and recommendations can inform practitioners, including social workers, as they support survivors/victims, particularly of campus sexual violence, in navigating the complexities of decisions about seeking support and/or justice.

An Online Transverse Study of Nurse Leaders' Cultural Humility in Nursing Practice as Perceived by Hospital Nurses.

INTRODUCTION: The term "cultural humility" is often used, but both society and professionals, including nurses, lack a clear understanding of its meaning. This study examined the relationships, predictors, and differences of nurse leaders' cultural humility in nursing practice, as perceived by hospital nurses. METHODOLOGY: A quantitative transverse and correlational study was implemented with a convenience sample of 350 Jordanian registered nurses (RNs). RESULTS: Nurses "agreed" on the presence of nurse leaders' cultural humility in nursing practice, but it was low. Working rotating shifts, holding a Baccalaureate degree in nursing or less, and having graduated from a private university predicted the perceived nurse leaders' cultural humility in nursing practice. Most differences in perceived nurse leaders' cultural humility in nursing practice came from nurses who worked rotating shifts when compared to those who worked day shifts. DISCUSSION: Nurse leaders must practice open communication and embrace a receptive mind-set, as this will help eradicate the tendency of nurse leaders to believe they know "know-it-all."

Tactics of just, equitable, diverse, and inclusive scientific research.

The principles of social justice, equity, diversity, inclusion (JEDI) have received increasing attention in behavior analysis circles, but the conversation has largely centered on implications for applied behavior analysis practice and research. It may be less clear to researchers who conduct basic and translational research how JEDI principles can inform and inspire their work. This article synthesizes publications from behavior analysis and other scientific fields about tactics of JEDI-informed research. We organized this scholarship across five stages of research from developing the research question to sharing findings and curated sources for an audience of behavioral science researchers. We discuss reflexive practice, representation, belongingness, participatory research, quantitative critical theory, and open science, among other topics. Some researchers may have already adopted some of the practices outlined, some may begin new practices, and some may choose to conduct experimental analyses of JEDI problems. Our hope is that those actions will be reinforced by the behavior analysis scientific community. We conclude by encouraging the leadership of this journal to continue to work toward the structural changes necessary to make the experimental analysis of behavior just, equitable, diverse, and inclusive.

Health, Salud, : Individualizing Behavioral Needs in a Multicultural World.

Diversity within the United States continues to increase, making it imperative that health care providers understand the impact of cultural background on health behaviors and perceptions. These practices promote trusting patient-provider relationships, improve outcomes, and increase patient satisfaction. In this article, we discuss the 3 largest ethnic or racial minority groups in the United States, Hispanics, African Americans, and Asians, and the intersection of culture and health care through the lens of these distinct communities. We also offer behavioral recommendations to increase awareness and knowledge regarding vast cultural variations within our communities while embracing cultural humility.

Addressing Teenage Pregnancy and Reproductive Health Among Latinx Adolescents and Young Adults.

Despite a national decline in teenage pregnancy rates, Latinx and Black individuals continue to have higher teenage birth rates compared with White teens. In the United States, Latinx females (ages 15-19) are more than twice as likely to have a teenage birth compared with non-Latinx White teens. With an increasingly diverse nation, a shift toward culturally inclusive approaches to care is critical to achieving equitable patient outcomes. Improving access to preventive care, workforce diversity, and insurance coverage will lead to cost-savings and help restore trust in a system that has failed past generations. In this commentary, targeted recommendations tailored specifically toward Latinx women will be provided, including culturally competent birth control counseling and a focus on reproductive justice. Not speaking English, low socioeconomic status, acculturation, legal status, and being uninsured are all teenage pregnancy risk factors unique to Latinx women. Cultural preferences and attitudes toward contraception must also be considered. Further expansion of Medicaid insurance coverage is also necessary to increase reproductive access among vulnerable populations. A cultural humility framework to reproductive health counseling and services is recommended. Within this framework, family engagement is encouraged, and women are free from reproductive coercion; they have the freedom to access over-the-counter contraception and receive guidance and support from providers and community health workers who are cognizant of culture and heritage. An integrated community-based approach that is culturally sensitive and in tune with Latinx heterogenicity is necessary to lower teenage pregnancy rates and achieve reproductive justice.

Exploring The Impact of Acceptance and Commitment Based Cultural Humility Training on Standardized Patient Interactions: Revisiting the Measurement Process.

Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based on Acceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.

The development and current directions of a diversity specialty clinic: Implications for multicultural training in psychology.

Addressing systemic injustices and racism in training and clinical service provision are key next steps in clinical science. While the APA Multicultural Guidelines and accreditation standards have long emphasized this need, most graduate programs offer a single course on diversity, equity, and inclusion topics, which is inadequate to train and sustain culturally humble providers and redress systemic injustices and racism within psychology. Few "real-world" examples exist to guide the development of training models. We provide background on the development and components of a specialty clinic, the University of New Mexico's Cultural Counseling Center, whose mission is providing culturally informed clinical services to diverse clientele, and to infuse multicultural training throughout the graduate program. Informed by the racial-spatial framework for psychology and critical race theory, we describe our approach intended to: 1) offer applications for the operationalization and delivery of multicultural and antiracist training; 2) enhance supervisory models; and 3) increase awareness of structural competence. Our clinic, developed collaboratively among students and faculty, serves as a safe forum for dialogue around structural injustices and seeks to improve treatment for diverse clients and those underserved in mental health care. We discuss issues of student and faculty engagement and offer the perspectives of faculty and students of color, case examples illustrating our services, and current efforts to expand and formalize community collaborations. We offer a model that integrates coursework, informal activities, and multicultural supervision for comprehensive student training and that promotes a departmental culture of dialogue and support around equity, diversity, and justice.