Continuing Education Requirement: Why Is There an Emphasis on Addressing Diversity in Every Program?

diversity is a critical consideration for all of us for two major reasons.

Susan Cohen Esquilin, PhD

CE Diversity Requirement

Last year, NJPA received a fiveyear authorization from APA to grant psychology continuing education (CE) credits. This was a major accomplishment, as the application for this authorization was detailed and complex, and not all applicants, including other state psychological associations, received such authorization. Among other requirements, NJPA had to demonstrate to APA that issues of diversity would be addressed in every program or publication for which we would grant CE credits. In addition, when APA reviews our programs at annual intervals, NJPA must present evidence that we did what was required, i.e., that issues of diversity were, in fact, addressed. Over the last few decades, APA drafted and redrafted guidelines for work with a variety of demographic groups. Most recently, the importance of attention to diversity has been underscored by new APA multicultural guidelines (American Psychological Association, 2017) and guidelines on practice with boys and men (American Psychological Association, Boys and Men Guidelines Group, 2018), as well as work this year in APA on the development of guidelines for work with people of low income and economic marginalization and of guidelines related to race and ethnicity.

Some of our colleagues have questioned both the need for a requirement about addressing diversity in every continuing education endeavor, as well as our routine inquiry in the evaluations of each presenter at the end of every program about whether each presenter met this requirement. Some feel this attention to the issue of diversity is excessive or irrelevant. However,

Addressing

Diversity Furthers the Scientific Basis of Our Professional Work

Psychology views itself as a science, and applied psychology prides itself on using research-based evidence as the undergirding of its assessment and treatment interventions. When we learn a new intervention technique, we want and need to hear about the evidence that supports its usefulness. The question is whether the individuals with whom this technique has been used represent our client in significant ways. Has this technique been examined with clients of a variety of racial or ethnic backgrounds, including the background of our specific client? Have studies found a difference in the way men and women respond to this technique? If the subjects who have been studied are primarily White, middle class Americans, should we try the technique anyway on a client who is different from that demographically? What might we want to consider if we apply this technique to a member of a group who has not been considered in any of the research? So, the current requirement for a program approved for CE is that, prior to the program, the presenter should research the question of the characteristics of the people on whom this technique has been developed and studied. And, in the absence of available research, the presenter should raise for consideration by participants the issues that they might expect would arise if the technique is used with a person from a demographic group that is not part of the sample studied. Similarly, a discussion about a new assessment instrument should make clear who was in the normative sample. There will always be limitations regarding this question, and those limitations should be identified. Those limitations may include the complete absence of certain groups (immigrants are often omitted) and the underrepresentation of certain groups as compared with their numbers in the population (this has often happened regarding Black people). In addition, a new assessment should report whether there are differences in how the various groups performed on the assessment instrument and provide different tables for each group or make suggestions for how to adjust for such differences in scoring. The PAI manual, for example, points out that a difference is found between White and Black participants in the standardization sample regarding only the paranoia scale. The manual discusses the likely reason for that difference and recommends a strategy for adjusting for it. Any of these shortcomings should make us cautious about relying on such an instrument for conclusions about people who are inadequately accounted for in the validation studies, and anyone presenting about a new technique should be calling attention to those limitations. Again, it would be useful in a CE presentation to then engage in a discussion with participants about what further research is needed and/or about how to use the assessment technique cautiously.

Importance of Awareness of Diversity on Clinical Rapport

New Jersey is one of the most diverse states in the United States with regards to ethnicity and religion, so the issue of diversity is particularly relevant for professional work in New Jersey. Estimates made in late 2018 indicated that, racially, New Jersey is 68.1% White, 13.5% Black, 9.2% Asian, 6.4% other races, 2.5% two or more races. Almost 40% of the population speak languages other than English, with Spanish as the most common non-English language spoken by 16.4% of the population. New Jersey is the state with the second largest Jewish and Muslim populations. It has the most Peruvians, the second largest population of Cubans, with very high numbers of Portuguese, Brazilians, Arabs, Chinese, and Italian Americans. (New Jersey Population 2019, 2018).

The issues raised by diversity are omnipresent, whether we are aware of them or not. A lack of awareness on our part can easily disrupt developing therapeutic alliances with clients. The clients we evaluate and treat represent a vast array of human differences based upon a variety of variables, including race, gender, socioeconomic status, sexual orientation, religion, ethnicity, ability status, immigration status, and developmental stage. In addition, we are increasingly recognizing the importance of intersectionality, e.g., how race and gender may intersect to produce significant differences in the challenges people face, in how people experience the world, and in the difficulties they present. The experiences and difficulties of White women and Black women may be very different in significant ways, so it may not be sufficient to understand something about women or something about Black people to have a more nuanced understanding of the status of being a Black woman.

Some differences are obvious when we look at a client, but many differences are invisible. We learn about them only if we are open to hearing about them. If we do not entertain the possibility that this client has a significant hidden identity that is crucial to understanding the client, we may never hear about it and the client may, in fact, simply withdraw from treatment because the client senses that we are closed to his/her experience. These hidden identities may include membership in a subculture that endorses activities that are alien or unfamiliar to the psychologist or that the psychologists never even considered might exist (e.g., a gun subculture).

Conclusion

As individual psychologists, and as a profession, we are constantly learning. As we recognize the many ways that clients may differ from one another, we must learn to integrate this recognition into our work. If our treatment and assessment methods are not built on research inclusive of people from different backgrounds, then our work is limited in its applicability and effectiveness. The new CE requirement will broaden the scope of both our sensitivity to what we do not know as well as increase our knowledge and skills about what the research has already found. Both our growing skills and sensitivity will improve our competency as individual clinicians and the esteem in which the public holds our profession. ❖

References:

American Psychological Association (2017). Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. Retrieved from <http://www.apa.org/about/policy/ multicultural-guidelines.pdf>

American Psychological Association, Boys and Men Guidelines Group. (2018). APA guidelines for psychological practice with boys and men. Retrieved from <http://www.apa.org/about/policy/ psychological-practice-boys-menguidelines.pdf>

New Jersey Population 2019 (2018, November 30). Retrieved from <http://worldpopulationreview.com/ states/new-jersey-population/>

About the Author

Susan Cohen Esquilin, PhD, is in independent practice. Trained as a clinical and developmental psychologist, she currently focuses her practice on forensic issues. Dr. Esquilin is president of the Essex-Union County Association of Psychologists, a member of the NJPA Committee on Diversity and Inclusion, co-chair of the Immigration Emergency Action Group, and a member of CoCEA (Council on Continuing Education Affairs).

Continuing Education Instructions: Visit <www.psychologynj.org> and find the CE Homestudy Library link under the Learn tab. This will take you to the online library where you will find the article and evaluation.