by Jaisal Merchant, M.A., Washington University in St. Louis
As a clinical science graduate student engaged in efforts to advance diversity, equity, inclusion, and justice (DEIJ) in our training programs, I was honored to be part of the introductory talk on Equity and Justice in Clinical Science at the APCS Summit alongside incredible researchers Joanne Davila and Stacy Frazier. Our introductory talk on the topic aimed to highlight the inherent compatibility of a justice-centered approach with clinical science and the critical need to center this approach in our field.
For many graduate students (myself included), the choice to pursue clinical science stemmed, in large part, from a desire to utilize research and practice to contribute to goals related to DEIJ: to disrupt the accelerating mental health crisis, reduce disparities, and improve access to quality mental health care, especially for historically harmed and marginalized groups. Thus, many students dedicate significant time and energy, beyond the extensive graduate school hours, to contribute to efforts to make psychological science more socially responsive. During the racial reckoning of 2020, people were especially angry and energized to push for these changes. A number of student-led DEIJ initiatives—including DiSSECT, the student group which I co-founded and co-lead—were initiated during this time. Although the desire for these shifts in our field remains, I have seen the energy toward them steadily dissipate over time. The pressure to progress rapidly in our work as clinical scientists persisted and unfortunately DEIJ efforts are often not included in the conceptualizations of this productivity. However, our goals towards progressing as clinical scientists should not be considered distinct from those towards advancing DEIJ in our field. For a field built on the recognition that integrating science and practice, seemingly disparate “parts,” strengthens our knowledge base, it stands out that DEIJ remains siloed, as a standalone “part,” rarely centered as a lens through which our work should be informed.
In our talk, Joanne Davila, Stacy Frazier, and I urged attendees to consider how our current approach to clinical science may be blinding us, and to consider what it could look like to use DEIJ as a guiding principle in our science. Ample evidence suggests that our clinical science, in its current form, has failed to ameliorate the burden of mental illness and meet societal needs, particularly when it comes to health equity; it lacks representation of marginalized and minoritized individuals both in its scholars and in the communities considered and reached. We challenged our fellow clinical scientists to consider how we define and build the evidence that forms the basis of our assumptions in the field. From randomized controlled efficacy trials that may be over-designed for research contexts and under-designed for the real-world, to research designs that often promote non-inclusive samples, we have produced an evidence base that overlooks cultural and contextual barriers and limits the relevance and reach of our treatments.
To better target these unmet needs, we posited centering equity and justice in our clinical science and spoke to the compatibility of these approaches. By focusing on the promotion of public health, integrating knowledge about systems of inequity into our training, and expanding upon the commonly taught research methods in our training programs we could increase the relevance and reach of our work. We encouraged attendees to consider how using such a justice-centered approach and reframing our fixed views of scientific success, is critical to training a diverse group of innovative scientists for whom advancing DEIJ is inherently associated with success as a clinical scientist.
Admittedly, I was a bit wary about the reaction to our talk and the ensuing conversations about DEIJ in the summit. I considered the potential irony that some of the concerns we had highlighted would be reflected in the trajectory of the summit. Would conversation about equity and justice in clinical science again be siloed into the bounds of its “section”, discussed with fervor by a few and skepticism disguised as empiricism from others, then forgotten amidst the other topics that are all too often seen as distinct from DEIJ? To my pleasant surprise, this was largely not the case. From the opening address onward, summit discussions incorporated conversation about the need for increased accountability to move the needle for public health, reduce opportunity gaps, and diversify our scientific agendas. Interestingly, many of the same discouraged sentiments I have heard from students about loss of confidence in our system and our science in its current form were echoed by top researchers in the field—those whose voices and efforts have power and potential to make necessary changes. There were conversations about how to increase commitment to these goals and reduce the burden on any given individual by sharing resources across universities. So, while a complete shift to a justice-centered approach to clinical science approach is likely unrealistic in the near future, the conversations at the summit provided a semblance of hope that these efforts will be prioritized at a number of levels in our clinical science programs.
Disclaimer: The views and opinions expressed in this newsletter are those of the authors alone and do not necessarily reflect the official policy or position of the Psychological Clinical Science Accreditation System (PCSAS).