Diversifying Clinical Child and Adolescent Psychology: A Change Gonna Come

Abstract

Objectives:

Workforce diversity is an ongoing challenge in the field of clinical child and adolescent psychology. This article discusses individual, institutional, and non-specific factors that contribute to a lack of diversity among clinical child and adolescent psychologists and offers suggestions to diversify and advance the field of clinical child and adolescent mental health.

Method:

Seventeen professors, licensed psychologists, faculty, and clinicians in the field of clinical child and adolescent psychology answered questions about workforce diversity and who is permitted access to the field. No formal research was conducted.

Results:

Individual factors included: racial discrimination and microaggressions, feelings of isolation, otherness, and not belonging. Institutional factors included: racism in academia, racial underrepresentation, ethnocentric and culturally-biased training, biased admissions selection processes, financial barriers, and lack of institutional commitment. Nonspecific factors were: values misalignment, hidden expectations, suboptimal mentoring, and limited research opportunities.

Conclusions:

Drawing on recent scholarship and the Contexts, Actions, and Outcomes (CAO) Model (Wood & Palmer, 2014), we recommend institutional changes in programs, policies, practices, resources, climate, partnerships, and inquiry to improve diversity in the field of clinical child and adolescent psychology.

“I was born by the river, in a little tent/Oh, and just like the river/I’ve been running ever since It’s been a long/A long time coming/But I know a change gonna come/Oh, yes it will”

On October 8, 1963, American singer-songwriter Sam Cooke, his wife, and entourage were turned away from a Whites-only motel in Shreveport, Louisiana and arrested a short while later for disturbing the peace. Cooke had been deeply moved by Bob Dylan’s Blowin’ In the Wind, but was initially afraid he would alienate his White fan base if he wrote about racism. Inspired by Martin Luther King, Jr.’s “I Have a Dream” speech at the March on Washington, Cooke later said his hit record, A Change is Gonna Come, came to him in a dream in late 1963. “I was born by the river,” Cooke wrote and “like the river / I’ve been running ever since.”

As career clinical child and adolescent psychologists and trainees, we, too, feel like we’ve been running “ever since.” Fifteen years after Hall (2006) predicted “continued inertia” in clinical psychology’s attempts to address diversity, we are unafraid, for fear of backlash, to disturb the proverbial peace. We are unafraid to name lack of diversity among clinical child and adolescent psychologists as harmful to all children and adolescents, especially Black, Indigenous, and People of Color (BIPOC) youth. We are unafraid to name racism as a contributing system to the lack of diversity and the inequitable treatment of BIPOC children and adolescents.

In this editorial-style manuscript, we reflect on our own experiences and those of respected and trusted colleagues regarding individual, institutional, and non-specific factors and systems that contribute to a lack of diversity among clinical child and adolescent psychologists. Building on recent scholarship advocating for antiracism in clinical and psychological science (e.g., Buchanan et al., 2021; Galán et al., 2021; Neblett, 2019; Rodriguez-Seijas et al., in press), we amplify, extend and supplement recommendations for meaningfully diversifying the field. Despite resistance, inertia and entrenched systems (Settles et al., 2019) that contribute to racial inequity in clinical child and adolescent psychology, we, too, believe, as Cooke proclaimed, “a change gonna come.”

Background, Introduction, and Approach

The underrepresentation of BIPOC students, faculty and practicing psychologists (Callahan et al., 2018) is a longstanding trend in the field. In 2020, the United States (U.S.) population identified as 59.3% non-Hispanic White, 13.6% Black, 18.9% Hispanic/Latinx, 6.1% Asian, 1.3% American Indian and Alaska Native, 0.3% Native Hawaiian and Other Pacific Islander, and 2.9% two or more races (U.S. Census Bureau, 2020). Yet, 68.5% of psychology students/trainees identified as non-Hispanic white, 10.6% Black, 9.8% Hispanic/Latinx, 7.2% Asian or Pacific Islander, 0.7% American Indian and Alaska Native, and 3.2% two or more races (APA, 2016, 2018). Among psychology faculty, 78% identified as non-Hispanic White, 5% as Black, 5% as Hispanic/ Latinx, 10% as Asian, and 2% other racial/ethnic groups (APA, 2019). For practicing psychologists, 84% identified as non-Hispanic White, 4% Black, 5% Hispanic/Latinx, 4% Asian, 0.3% American Indian and Alaska Native, 1.5% of two or more races, and 2% other racial/ethnic groups (APA, 2018). Consistent with the broader pattern of underrepresentation, the APA Center for Workforce Studies reported that 83% of the psychology workforce self-identified as White, while only 3% identified as Black (APA, 2022). These statistics, coupled with higher attrition among BIPOC trainees from doctoral programs (Callahan et al., 2018) compared to their White counterparts, highlight significant discrepancies that exist in the field of psychology relative to the general population and underscore the need to diversify not only clinical psychology but also clinical child and adolescent psychology.

Clinical child and adolescent psychologists are fewer in number, as compared to clinicians serving adult populations (APA, 2016) and suffer from similar problems with underrepresentation; thus, diversifying the field is critical to clinical child and adolescent mental health services and treatment. As of 2020, the majority of children under the age of 18 belonged to ethnic-racial minority groups, with ethnic-racial minority groups expected to constitute the majority of the U.S. population by 2043 (Zinn et al., 2016). BIPOC children, youth and families are less likely to receive high quality care (McGuire & Miranda, 2008), despite being inequitably exposed to potentially traumatic experiences (López et al., 2017), and, in recent years, are more likely to experience adverse mental health impacts of the COVID-19 pandemic (Golberstein et al., 2020). Improving diversity in the field can: 1) increase scholarship from BIPOC clinical child and adolescent psychologists who develop the evidence base for culturally-relevant models and treatments; 2) inform and advance equitable local, state, federal, and international youth and family health policies; and 3) lead to the effective delivery of clinical treatments with and appreciation for the roles of individual and systemic racism on BIPOC youth treatment and health.

Recent scholarship examining racism and antiracism in clinical and psychological science (Buchanan et al., 2021; Buchanan & Wiklund, 2020; Galán et al., 2021; Neblett, 2019; Rodriguez-Seijas et al., in press), as well as scholarship on diversity, equity, and inclusion (Callahan et al., 2018; Fuentes et al., 2021; Settles et al., 2020), has not focused specifically on clinical child and adolescent psychology, but provides important insights for understanding macro and micro level factors that may contribute to a lack of diversity in the field. Buchanan and Wiklund (2020) suggested that resistance to social justice, intersectionality, and diversity frameworks in clinical science may lead clinical psychologists of color to consider leaving the field (see also Settles et al., 2019), thus reducing the number of diverse scholars, policy influencers, and clinicians. Buchanan et al. (2021) argued that current practices (e.g., how science is conducted, reported, reviewed, and disseminated), may maintain White supremacy and discourage BIPOC scholars from pursuing research careers. Settles et al. (2019) proposed that epistemic exclusion or “devaluation of some scholarship as illegitimate and certain scholars as lacking credibility” leads to the exclusion of BIPOC scholars from mainstream journals and that “dominant psychologists act as gatekeepers” (p. 796) to the field. Moreover, daily racism and microaggressions experienced by self and marginalized others (Buchanan & Wiklund, 2020; Galán et al., 2021), tokenization, lack of diverse faculty, unsafe and hostile environments and climate (Buchanan & Wiklund, 2020), biased admissions criteria, and insensitive and outdated and ethnocentric curricula, classroom pedagogy, course syllabi (Fuentes et al., 2021) and training (including supervision), all have been implicated as additional factors that contribute to a lack of diversity in the field. Importantly, these factors may shape decisions about not only exiting, but also joining, the field and impact decisions about research and clinical practice careers.

In this reflection piece, we draw on our own experiences as a Black male clinical science graduate student, early career professionals (2 Black females, 3 Black males and 1 Asian American male), and a Black male full professor, all with research and clinical expertise in child and adolescent mental health, as well as comments from a set of questions sent to a small, but diverse group of child and adolescent psychologists¹ to explore diversity and gatekeeping in the field of child and adolescent psychology. Our aim was not to conduct formal research; rather, we sought to reflect on various factors that shape workforce diversity and gatekeeping, as informed by our collective experiences and those of our colleagues. To inform the questions we asked, we generated an initial list of questions about contributing factors to a lack of diversity among child and adolescent psychologists and ideas for meaningfully diversifying our field. We grouped the questions, and subsequent responses, thematically, which resulted in three foci – individual/interpersonal, institutional/structural, and nonspecific factors – as well as solutions to the problem. In the sections that follow, we draw on our own experiences and the comments and experiences from our colleagues to explicate, amplify, and extend recent scholarship and present suggestions for diversifying the field.

Individual/Interpersonal Factors

“It’s been too hard living…”

Racial Discrimination/ Microaggressions

In this first section, we reflect on individual and interpersonal factors, reflective of what Cooke called “too hard living,” that may contribute to a lack of diversity among child and adolescent psychologists. We define individual/interpersonal factors as experiences occurring personally or at the level of the individual. The overwhelming majority of our colleagues identified racial discrimination experiences and microaggressions by faculty and fellow peers, trainees, and students (see Galán et al., 2021) as a key individual/interpersonal factor that undergirds the lack of diversity among child and adolescent psychologists. Racial discrimination refers to differential treatment based on beliefs of the racial superiority of one group over another (Jones, 1972). Microaggressions refers to more subtle forms of discrimination such as unfriendly verbal and nonverbal communications that reflect prejudicial assumptions, inequities, and unjust behavior toward members of minority groups (Sue et al., 2007). Examples provided by colleagues included: disparaging messages by faculty members (“you’re not going to succeed”); insensitive clinical supervision (e.g., making disparaging comments about a client’s race, ethnicity, or culture); being evaluated more harshly on assignments and in practicum as well as in front of classmates; insensitive and offensive faculty questions (e.g., during defense meetings); treating BIPOC trainees as spokespersons for their race; tokenism (i.e., being “one of the only”, if not “the only” BIPOC in a department or professional setting; see Callahan et al., 2018); lack of appropriate responsiveness and consideration of current events (e.g., murders of George Floyd and Breonna Taylor); adopting and promoting color-evasion racial ideologies²; resistance to addressing diversity and multiculturalism and to providing accommodations for disability, learning challenges and racial trauma (i.e., cumulative emotional and psychological injury from direct and vicarious exposure to racial stress); and anachronistic training materials that inaccurately portray BIPOC children and adolescents. These experiences resonated with many of the early career co-authors who recalled: being mistaken for other BIPOC trainees and even other BIPOC faculty by White peers and instructors and being given feedback that their hair or attire was unprofessional. Navigating encounters with racial discrimination and microaggressions are consistent with experiences identified in recent scholarship (Callahan et al., 2018; Galán et al., 2021) and transmitted clear messages regarding values and priorities within departments and institutions. These experiences led to colleagues reporting decreased confidence, lack of trust in supervisors and mentors, and to questioning their belonging in the field.

“I go to the movie/And I go downtown/Somebody keeps telling me/Don’t hang around”

Isolation, Otherness, and Not Belonging

In addition to discrimination/microaggressions as contributing factors, our colleagues described a range of individual and personally-mediated feelings that resulted from these adverse experiences that they believed might contribute to lack of diversity in the field. Three common feelings engendered by these experiences included “isolation”, “otherness”, and “not belonging”. One colleague suggested that perceived lack of support for personally meaningful events and apathy on the part of colleagues and professors about personally meaningful experiences and events (e.g., attending a Black Lives Matter rally; Charleston church shooting; murders of Alton Sterling and Philando Castile; racial reckoning events of 2020) contributed to feelings of isolation within their department. Another colleague suggested that treating White and Eurocentric norms as universal facts contributed to feelings of isolation, since these “facts” overlooked, silenced, or minimized non-White perspectives and the diverse experiences of BIPOC students and faculty. While the centering of whiteness is also reflective of institutional and structural forces, as we discuss below, this approach was experienced by our peers personally with implications for their sense of belonging in the field. The link between larger systemic forces and individual and personal experiences belies an important observation: while we framed the questions in terms of individual, institutional, and nonspecific factors, there is overlap between the factors such that it is not always possible to isolate and distinguish the factors from one another.

Other Individual/Interpersonal Experiences

In addition to microaggressions and feelings of isolation, otherness, and not belonging, our peers described a wide range of additional individual/interpersonal factors that they believed contributed to a lack of diversity in clinical child and adolescent psychologists. For example, one colleague lamented being assigned cases solely because of their race and not because the cases were a good fit to their training goals. The senior author of this manuscript remembers, from his own training experiences, being assigned almost all cases for which a Black male therapist was requested, which led to a limited range of cases (primarily Black boys). Another colleague indicated that trainees might feel overburdened by having to carry the weight and responsibility of their program’s multicultural initiatives – an experience which several early career co-authors of this manuscript, who were tasked with leading their program’s Diversifying Psychology weekend, could appreciate. A third colleague identified a general lack of awareness that faculty and peers may have regarding issues that disproportionately burden those coming from historically marginalized backgrounds (e.g., the weight of unarmed shootings, loss of loved ones during the pandemic, etc.). Collectively, the prevalent and cumulative nature of these negative individual and interpersonal experiences, described herein, can make academic and professional spaces feel unwelcoming to BIPOC students and scholars, thus reducing the likelihood that they will advance and matriculate in the field of clinical child and adolescent psychology.

Institutional Factors

“Then I go to my brother/And I say, brother, help me please/But he winds up, knockin’ me/Back down on my knees”

In A Change Gonna Come, Cooke’s reference to his “brother,” whom he asks for help, but unfortunately still ends up empty-handed, has been interpreted as a metaphor for “the establishment.” In this section, we highlight institutional factors that we and our colleagues thought hampered diversity in clinical child and adolescent psychology. These factors are defined as consequences or a natural extension of the practices of institutions, or individuals or collectives of individuals who hold power, that impinge on the rights, access, and outcomes of individuals (Harrell, 1999). Unfortunately, even with some institutional supports in place, BIPOC professionals and trainees may still feel like they’ve been knocked back down “on (their) knees.” Indeed, our peers cited numerous institutional factors that contribute to a lack of diversity among clinical child and adolescent psychologists such as: racism in the academy; racial underrepresentation; ethnocentric and culturally-biased training; problematic graduate admissions processes (e.g., overreliance on standardized tests that are systematically biased) and definitions of “success” (e.g., prior attendance at a “prestigious” undergraduate institution); financial barriers; and a general lack of institutional commitment to diversifying clinical science. Across these factors, colleagues collectively highlighted a tendency for institutions to maintain the status quo and gravitate towards the privileging of whiteness (i.e., White supremacy; see Huff, 2021).

Academia is Toxic

Too many of our peers characterized academia as a “toxic” and unsafe space in which racism is rampant and environments are unsupportive leading many to “just want to get in and out”. Several participants described a campus climate characterized by a lack of awareness of matters important to BIPOC trainees and a lack of cultural humility (i.e., an ongoing, lifelong commitment to self- introspection and reflection characterized by “respect and lack of superiority toward an individual’s cultural background and experience” (Hook et al., 2013, p. 353; see also Tervalon & Murray-García, 1998), which in turn fueled microaggressions like the ones described above. As an example, colleagues described the field and university environments, in particular, as racially hostile and uncomfortable settings devoid of mentors invested in racial and ethnic minority success and safe spaces (see Galán et al. 2021) to process, heal, and grow and to voice concerns about training and the toxic environment. Colleagues also noted that accountability mechanisms (Buchanan et al., 2021; Galán et al., 2021), or the lack thereof, contributed to failure to appropriately attend to BIPOC students’ needs in the environment. Oftentimes, faculty are not held accountable for insensitive comments, and mechanisms that allow anonymous reporting of comments or problematic events remain limited. Some colleagues felt that problems with accountability were not only specific to insensitive comments or discrete events, but also noted that there were no mechanisms in place to hold faculty accountable for integrating diversity into their teaching or other diversity-related efforts that might help to diversify the field.

Racial Underrepresentation

Underrepresentation was a second institutional factor identified by colleagues. Participants identified the limited number of BIPOC students, faculty, mentors, clinicians, scholars, principal investigators (PIs), and supervisors in the field (documented above) as a continued hindrance in the field that actively perpetuates the notion that clinical child and adolescent psychology is a field where only White individuals can be successful. This erroneous belief is seldom challenged, as the limited number of BIPOC faculty, clinicians, and/or supervisors makes it difficult for BIPOC students to have a mentor who can provide mentorship through a lens that acknowledges the unique experiences associated with their marginalized experiences. Indeed, multiple colleagues indicated that they did not see a person of color within psychology, or specializing in clinical child and adolescent psychology, until they were already in graduate school. As a result of underrepresentation, opportunities to engage in research, clinical work, and professional development activities that may be perceived as personally meaningful, may be limited which, in turn, can directly influence the likelihood that BIPOC students will pursue graduate degrees and careers in clinical child and adolescent psychology. Colleagues noted that research labs were not diverse, which may lead to racially and ethnically diverse students being less inclined to join those labs, as faculty mentors may not be asking questions that interest them or that feel relevant to the work that they want to do. Trainees may also feel they don’t belong (Callahan et al., 2018) if they don’t see others in those spaces with similar experiences and who look like them (Huff, 2021). As shared by one peer, training experiences in labs not involving BIPOC PIs may create unwelcoming or hostile environments, leading students of color not to pursue research opportunities that are necessary for competitive graduate school applications. The relevance of underrepresentation is also prevalent among BIPOC graduate students, clinicians, and even early career faculty, and can ultimately shape whose experiences and realities are considered and discussed, in turn limiting how prepared and equipped trainees and professionals feel to pursue and continue a career within the field.

Ethnocentric and Culturally-Biased Training

Colleagues noted that problems with ethnocentric and culturally-biased training represented another institutional factor that could contribute to a lack of diversity in the field. For example, training experiences (e.g., how to talk about race with clients) often assume the trainee is White and center the experiences of White therapists and trainees. One of the authors recalled completing “diversity” trainings that centered White clinicians working with BIPOC families and youth and failed to offer meaningful guidance on how BIPOC trainees could navigate the unique dynamics of inter- and intra-racial relationships with family and youth clients. Even the very definitions and conceptualizations of children and families can be culturally biased and deficit-oriented. As an example of the latter, one author recalls that, during their training, Black families were typically used in examples of family dysfunction, but White, two-parent, families were used in examples of positive adjustment. Furthermore, while there have been some improvements, there is insufficient training around approaches to diversity for children and adolescents who are not White, Christian, or able bodied. Even when faculty are well-intentioned, unintended harm can occur. Students, clinicians, and faculty need to be skilled at discussing group differences in a sensitive manner (i.e., presenting material in a manner so as not to “other” BIPOC children, youth and families - “this group does x” - and acknowledge heterogeneity within groups), which is consistent with APA guidelines pertaining to multicultural competence (APA, 2017). Yet, courses and trainings pertaining to multicultural considerations within clinical and research settings remain few and far between, which transmits a clear message regarding its perceived importance and value by the broader psychology community. This dearth of training does a disservice to the field and serves to reinforce erroneous biases relating to conducting research among BIPOC communities and youth, including the need for a White control group. Failure to consider the inclusion of BIPOC youth in research studies, treatment of psychological science as ahistorical (i.e., not rooted in scientific racism), failure to consider how racism operates in the very systems in which students are receiving training (e.g., bias in child protective services), and the overvaluing and over-emphasis of White, European values and norms to the exclusion of other groups, may contribute to decreased interest in the field.

Graduate Admissions Selection Processes and Definitions of “Success”

Our colleagues indicated that heavy emphasis is placed on traditional markers of success, which often undermines the accomplishments of BIPOC students and PIs. As an example, despite the poor predictive validity of the graduate record examinations (GRE) (Moneta-Koehler et al., 2017) and its role in limiting equitable access to graduate level education (Bleske-Rechek & Browne, 2014; see also Calahan et al., 2018), institutions have been slow to eliminate or reconsider the GRE as a part of graduate applications. As such, potential BIPOC applicants might be hesitant to apply to graduate school due to low GRE scores. At the faculty level, greater attention is paid to indicators such as teacher ratings, number of publications, journal impact factors and federal funding (e.g., National Institutes of Health [NIH] grants) while less attention is paid to the mentorship of undergraduate students (Galán et al. 2021). Importantly, review processes fail to appreciate the potential bias in these indicators, such as lower teacher ratings for female BIPOC faculty (Flaherty, 2015) or undervaluing of so-called “race scholarship” and “specialty journals,” which can, in turn, lead to decreased sense of belonging in the field (Settles et al., 2020). Further, tenure processes promote a culture of individualism and competitiveness, de-emphasizing department communitarianism and community-partnerships, which may come at a disparate cost to BIPOC scholars who use community-based research methodologies. Moreover, metrics of success may not reflect the full range of BIPOC faculty service and unintentionally disadvantage BIPOC faculty who make important contributions that are not captured by these metrics.

Financial Barriers

Colleagues noted that financial barriers are present from the beginning of training to the end. For example, accepting an unpaid research assistant position at the undergraduate and/or post baccalaureate levels is more feasible for individuals with generational wealth and/or financial support. This disparity places those without research experience at a significant disadvantage as they submit their graduate school applications. Further, during the application process, information regarding financial support may be absent or difficult to find. As graduate students, stipends are often meager and pay schedules are inconvenient (e.g., paying students at end of first full month). Additionally, there is typically no support available for hidden and/or unavoidable costs (e.g., relocation, security deposit, books). Unexpected fees and delayed checks and policies requiring reimbursement vs. cash advance can exacerbate school-related stress, which are further compounded by familial financial commitments and caretaking responsibilities that students may also be balancing. Further, students are required to complete clinical practica, yet are not compensated for transportation expenses, a burden experienced by many of the co-authors as graduate students who traveled across town multiple days per week to gain inpatient training experience. At the end of graduate school, students face high costs of internship applications, travel, and interviews that can total several thousands of dollars. Notably, many are unaware of these costs until it is too late to save, if that is even feasible. Indeed, many may already be managing loans from the costs associated with graduate school or even sending money home to help family members (Huff, 2021). At many schools, if students are unable to finish their dissertation prior to internship, they continue to foot a bill each semester despite their absence from campus at a time when they are underpaid and unable to seek supplemental income. Collectively, these financial factors may lead to significant hardship and, in some cases, precipitate a premature exit from training and the field.

Lack of Institutional Commitment

Lack of institutional commitment to diversifying the field was a recurring theme in responses to the institutional prompt. Colleagues noted that there were few internal and external fellowships (e.g., Ford Foundation, now scheduled to end in 2028) dedicated to diversifying the field and lamented misalignment between diversity as a purported priority and the commitment of actual dollars/allocation of resources to that priority. In some cases, institutional commitments appeared superficial and performative, lacking in substance, continuity, and results. As an example, colleagues pointed out that BIPOC students, staff, and faculty are made to be “hypervisible” on campus for recruiting initiatives and diversity and inclusion events, but receive little support (including compensation) before or after such programming. Early career co-authors recalled low faculty attendance at diversity events (e.g., movie night) and conversations about diversity often spearheaded by BIPOC students. These experiences were reflective of a larger pattern: the program’s commitment to diversity was more heavily emphasized in publication (e.g., website, training materials) than in practice, with images that included BIPOC students displayed on the website, misrepresenting actual commitment to diversity. Colleagues also observed that the places that were often most in need of diversity resources didn’t seem to have them. There was no shortage of promises to attend to faculty diversity, but commitment to actually do so (and results) never seemed to be enough (only a few faculty are hired each year), and already existing BIPOC faculty were spread thin (some departments had only one or no BIPOC faculty). If faculty diversity is a priority, one would expect that the approach to faculty hires would reflect a sustained commitment with innovative approaches to the challenge (e.g., cluster hires, creative outreach, leveraging networks, advertising in positions in places frequented by diverse candidates, guarding against homophily, etc.). Oftentimes, the commitment is not sustained, and institutional support and resources are needed to ensure students and faculty do more than arrive and survive, but ultimately thrive.

Non-Specific Factors

“Oh, there been times that I thought/I couldn’t last for long”

Values Misalignment

Attention must also be paid to the nonspecific or “invisible” factors that impact training, retention, matriculation, access to, sustaining a career, and enhancing diversity in the field of clinical child and adolescent psychology. For instance, the field of psychology is steeped in a tradition of scientific racism that has been used to oppress marginalized groups (Buchanan et al., 2021; Guthrie, 2004), and is based on Western/Eurocentric values that may go against more culturally-relevant values that are important to BIPOC scholars (i.e., Afrocentric values, intersectional identities, etc.). This “historical residue” in the field notably impacts training and diversity in a multitude of ways. In particular, colleagues noted that the field emphasizes the value of individualism, which may directly clash with values related to collectivism and communalism that are traditional to cultures of individuals from BIPOC backgrounds. The field also emphasizes conformity in writing, presentation, and the development of scholarly prototypes that may contrast the Afro-cultural theme or dimension of verve (Boykin, 1979), which emphasizes variation. This cultural misalignment may lead to feelings of isolation, a lower sense of community and connectedness with other scholars and professionals from majority white backgrounds, and a lower sense of belonging in the field. Or in other words, BIPOC scholars may feel as if when it comes to their success in the field of clinical child and adolescent psychology, “They don’t really care about us.” Moreover, this emphasis on individualism may also negatively impact opportunities for BIPOC individuals to collaborate, seek mentorship and support, and engage in other non-specific opportunities, which further impacts their ability and motivation to thrive in clinical child and adolescent psychology. Colleagues also noted that they had experienced resistance and or defensiveness from those in administrative/leadership roles when these institutions were asked to “change” or embrace diversity, equity and inclusion and other values such as communalism. Not surprisingly, this could lead to a sense of hopelessness in terms of feeling as if one does not belong in clinical child and adolescent psychology and/or at their respective institution, as well as feeling devalued or unimportant in these spaces.

Hidden Expectations

In the clinical child and adolescent psychology field, there are also what we term “hidden expectations” or a “hidden curriculum” for BIPOC students and faculty, referring to the responsibilities, obligations, and behaviors that BIPOC people may have to engage in in order to be successful. For instance, colleagues highlighted the “minority tax” which refers to the stress of engaging in a myriad of activities expected of or are important to BIPOC scholars. This could include being expected to engage in service activities related to diversity and inclusion efforts, being a resource for BIPOC students (e.g., extra mentoring, tutoring sessions, etc.) – which receives limited recognition in annual or promotion reviews – or experiencing pressure to represent one’s race in class, seminars, faculty meetings, etc. (see Faucett et al., 2022). These feelings may be especially exacerbated for BIPOC scholars who may be the “only one” in their department, expected to be knowledgeable about various other BIPOC identities, and/or who may have intersecting marginalized identities (e.g., women, LGBTQ individuals, etc.) while negotiating and carrying on their shoulders the weight of omnipresent cultural trauma and tragedies (e.g., police shootings). The consequence of not engaging in such activities could make others view BIPOC scholars negatively (especially BIPOC students and/or colleagues). Moreover, BIPOC scholars may want to engage in these activities because of aforementioned values related to collectivism, but doing so may come at the cost of increased stress and workload, experiences of discrimination, and reduced time to engage in clinical, research, and other scholarly activities important to continued success in the field. There are also many invisible social expectations that BIPOC scholars must engage in within the field including needing to appear to represent their race/or a fear of representing stereotypes about their race in social/professional settings (e.g., internship interviews) with others, having to advocate for members of their race in social and professional settings, and being expected to be experts in all things related to diversity and/or race-related concerns (Rockquemore & Laszloffy, 2008). Unfortunately, we resonate with many of the social expectations noted, as did many of our colleagues. These pressures may increase stress for BIPOC in these various settings, affecting feelings of belongingness and their motivation to continue in the clinical child and adolescent psychology field.

Suboptimal Mentoring

At the undergraduate level, colleagues noted the lack of good mentoring, rendering it challenging for BIPOC students to stand out as they seek admittance into graduate programs. Without an attentive and supportive mentor, it can be difficult for students to be aware of what is required (e.g., prerequisites to apply to, and successfully matriculate through, graduate programs (e.g., PsyD vs. PhD, masters vs. doctorate). In some cases, our peers described experiences whereby students were counseled to get an “MA” or steered to a master’s degree in social work instead of pursuing a PhD or told that it was “too late” for them to get the right experiences that would allow them to be competitive. Colleagues also noted mentors’ lack of familiarity with opportunities, resources, culturally-relevant conferences and seminars (e.g., APA Division 45 Conference, Black Graduate Conference in Psychology), professional organizations such as the Association of Black Psychologists, and so on, as a problem. This lack of knowledge hinders the ability of BIPOC students to attain targeted funding, training, and other opportunities to increase their competitiveness in the field as compared to their White peers. Furthermore, BIPOC faculty members and staff in the field may pay a price, as they may engage in additional unrewarded mentorship and service activities to help aid BIPOC students due to their cultural values. White colleagues, on the other hand, may not have this same responsibility or desire, therefore creating a disparity in service activities/effort that disproportionately hinder BIPOC faculty members’ productivity.

White clinical child and adolescent psychology faculty members may also have limited insight into the unique experiences/stressors that BIPOC students negotiate. These may include experiences of racial/gender identity/sexual identity discrimination, stereotype threat, impostor syndrome, the aforementioned “service/minority tax”, and other personal and culturally-specific experiences that BIPOC students encounter in the classroom and in their daily lives. Limited understanding or familiarity with these topics may lead to experiences where BIPOC students feel invalidated, hopeless, and frustrated, further reducing their motivation to continue in the field. As noted by one colleague, increasing lab diversity may actually be harmful to BIPOC students if the PI is not familiar with mentoring or supporting students from racial and ethnic minority backgrounds. These experiences may also be exacerbated by the power differential often present in these experiences between BIPOC students and White faculty member/career professionals.

Research Infrastructure and Opportunities

BIPOC professionals also noted how they are held to the same productivity expectations despite more barriers to accessing children and adolescent, family units, and BIPOC research participants. One author of this paper recalled changing her dissertation to focus on young adults after months of IRB revisions and applications and bids to school districts to access high school youth to conduct race-related research. She was eventually granted permission by IRB, but was denied access at the school level due to the school district citing that her work was not directly related to academic subjects (e.g., mathematics). Given increased research on “mechanisms” and other “popular” research methodologies (i.e., randomized controlled trials, machine learning, etc.) that rely on longitudinal, large, and complex sampling designs (e.g., matched samples), it may be difficult for BIPOC scholars that rely on exclusively BIPOC populations to recruit the appropriate samples to conduct such analyses for a variety of reasons (e.g., valid negative attitudes against participating in research due to historical unethical practices, barriers to participating in research and/or treatment due to existing disparities, geographic limitations). As one co-author noted, this issue becomes even more salient when located in rural areas, as the infrastructure to conduct research with BIPOC communities may be non-existent. In addition to additional time required to gain approval to conduct research with children and other vulnerable populations, these barriers may lead to an inability for emerging BIPOC scholars to attain competitive funding, extended time between data collection and manuscript publication due to the increased time-intensive nature of collecting such samples (e.g., community-based participatory research), and a reliance on other methodologies that mainstream journals undervalue and deem as “less rigorous” (e.g., cross-sectional studies, smaller samples, qualitative methods, community-based approaches, lack of reliance on easily accessible “college student samples”, etc.). These challenges hinder BIPOC scholars from attaining competitive higher education jobs, tenure, and other competitive positions, further suffocating the available number of BIPOC faculty members’ who can recruit and train future BIPOC students. Decreased numbers of BIPOC faculty, additively or perhaps multiplicatively, contributes to the lack of BIPOC representation in the clinical child and adolescent psychology field.

Change Gonna Come

“It’s been a long/A long time coming/But I know a change gonna come/Oh, yes it will”

We have described and illuminated several processes by which individual, institutional, and nonspecific factors could negatively impact the diversity of the field. Much like the river Cooke alludes to in the first verse, the field of psychology (and by extension clinical child and adolescent psychology) has been running in the same direction, maintaining the status quo, with regard to the diversity of the field and theoretical/epistemological frameworks. For some, the direction of the water is fine. For others (BIPOC trainees, faculty, professionals) the river, its water, current, and direction fail to lend itself to evolution in scholarship, diverse representation, value shifts, and other desired outcomes. So what do we change?

Shifting the river to bring about institutional (and structural) change will require a multi-step/multi-faceted approach that is the collective responsibility of the field and not the sole responsibility of BIPOC professionals (Buchanan et al., 2021; Galán et al., 2021). In this last section of the paper, we draw on the Contexts, Actions, and Outcomes (CAO) model of institutional responsibility (Wood & Palmer, 2014) to offer, amplify and extend suggestions from prior scholarship and by our colleagues that could enhance diversity among the clinical child and adolescent psychologist workforce. The CAO model suggests eight target areas that shift the responsibility of change from the individual to institutions: programs, policies, practices, resources, structures, climates, partnerships, and inquiry. Based on the individual, institutional, and nonspecific factors outlined above, we provide a non-exhaustive list of potential next steps in seven of the eight domains to promote diversity in the field of clinical child and adolescent psychology.

Programs

Programs is the first domain of institutional responsibility and refers to high-impact programming that could increase diversity in the field (Wood & Palmer, 2014). Examples include: opportunities for undergraduate trainees and professionals to engage in research, academically oriented clubs and organizations and community service that are relevant to clinical child and adolescent psychology, and generation of learning communities (e.g., faculty learning committees focused on increasing diversity in clinical child and adolescent psychology). In addition to extant research opportunities that provide trainees with the experiences to learn about research and opportunities to develop relevant skills (e.g., Summer Research Opportunities Program, McNair Scholars Program, Scholars Committed to Opportunities in Psychological Education (SCOPE³; see Huff, 2021; Silverstein et al., 2022), efforts could include training programs for faculty mentors and training programs for equitable admissions and holistic review (Galán et al., 2021; Mathur et al., 2019). Other recommended programs might include webinars, panels, school events, and other community forums for trainees, particularly at the secondary level (and maybe even earlier) that allow trainees to learn about what clinical child and adolescent psychologists do, how to get in the field, what it takes, and so on (Huff, 2021).

Policies

Policies refers to rules, standards, and procedures that shape how and when decisions are made that impact all members of the group whether they be trainees, faculty, or staff. Because vague policies and lack of transparency can compromise efforts to increase diversity, it is important that policies are clearly articulated and have buy-in from relevant stakeholders (Wood & Palmer, 2014). Recommended initiatives to promote equity include: eliminating the GRE as a graduate entrance requirement (a growing trend in U.S. graduate degree programs) (Galán et al., 2021); eliminating consideration of an undergraduate institution’s name in the admission process for graduate training (see Reyes & Uddin, 2021); masking names of letter writers (Galán et al., 2021); revisiting promotion and tenure policies to ensure that they recognize the full range of BIPOC faculty efforts, activities, and contributions and appreciate differences in the kinds of research and work that BIPOC faculty conduct and produce (Settles et al., 2019); establishing guidelines that take into account hidden service demands of BIPOC professionals; and establishing policies of accountability (Buchanan et al., 2021; Callahan et al., 2018; Galán et al., 2021). Accountability policies might be relevant for: a) complaints, conflicts, microaggressions, and racism experiences that impact BIPOC professionals; and b) compliance with predetermined commitments to diversity priorities (e.g., training, funding, hiring, recruitment etc.), taking into consideration various family roles and responsibilities (e.g., child/elder care), and ensuring equal pay and compensation for similar work.

Colleagues suggested that, in the event that units do not meet expectations, possible sanctions might include: loss of funding (e.g., assistantships) and not getting promotions, as well as additional trainings and support for those who do not work to dismantle systemic barriers or who work to maintain current policies and practices (e.g., resisting BIPOC student and family recruitment and retention efforts). Care should be taken to ensure that the adopted policies do not cause harm or worsen inequity. For example, while it might be beneficial to increase the number of diverse faculty or professionals in decision-making and governance bodies, requiring participation in such bodies could cause undue burden on the small number of diverse professionals in an organization.

Practices

Practices refers to formal and informal operations relevant to strategic planning, hiring, retention and advancement of personnel, trainees and their professional growth (Wood & Palmer, 2014). In addition to standard services that support students (e.g., academic advising, financial aid), examples could include: the practice of culturally-relevant and aligned pedagogy (Hogan & Sathy, 2022) in ways that might excite diverse students about entering the field (e.g., emphasis on communalism and verve); “intrusive” approaches to counseling diverse students whereby mentors seek out students who may be hesitant to engage in programming and services and actively monitor their progress; use of remote online interviews to reduce costs and travel expenses associated with internship interviews; the development of portfolio/holistic review processes in graduate admissions (Mathur et al., 2019); and strategic planning with an emphasis on identifying outcomes for success in increasing diversity as well as hiring, retention, and professional development.

Hiring and retaining faculty from historically excluded racial and ethnic backgrounds is important because of the impact that it can have on the overall matriculation of BIPOC individuals throughout the graduate student experience. Such hiring and retention practices are particularly important as the number of individuals who have received bachelors and masters level training in psychology has increased in the past two decades, but the number of individuals who have achieved a terminal degree has remained steadily low (Maton et al., 2006). Hiring faculty who focus on supporting and working with populations from racially and ethnically marginalized backgrounds is important to ensuring that students who have interest in working with these populations can pursue their research and clinical interests (Chandler, 2011). Additionally, a key component to retaining faculty is ensuring that they are promoted and allowed to advance in their careers. Strategic planning will require an operating body and well-specified mechanisms of action to achieve desired results. This body (and other positions of power and influence) should contain appropriate representation of BIPOC professionals, but again, not at the cost of their sanity and livelihood. Establishing a cross-disciplinary or even cross-institutional task force to identify barriers to diversity in the field and develop training guidelines for staff, faculty, and students could be a fruitful endeavor in the practice domain.

Resources

Resources are “financial, intellectual, and human capital assets at the disposal of the institution” (Wood & Palmer, 2014, p. 61). In light of financial barriers raised as an institutional factor influencing diversity in the field and how these barriers can be a hindrance to graduate student matriculation and training, financial assets are a critical resource for BIPOC trainees. Specific financial resources might include: increased student stipends and wages and other support such that students are less indebted (or not in debt) upon graduation. Financial resources should be provided for not only students, but also diversity initiatives coordinated by students, faculty, and administrators. If diversifying the field is a priority, then there needs to be allocation of funds to hire BIPOC faculty in clinical child and adolescent psychology, funds specific to training diverse students, and resources to support administrators in leading diversity efforts. In our experience, department chairs or a small group of faculty and students are frequently charged with leading diversity efforts without financial capital to support these efforts. Financial resources and assets should also be invested to examine and address racial funding disparities within the field of clinical child and adolescent psychology across federal and foundation agencies to increase the number of historically underrepresented individuals who have access to the field. The recent NIH U.N.I.T.E. is one such example at the federal level (“Ending Structural Racism”, n.d.).

Although our primary focus here is on financial assets, we also encourage consideration of other resources that might be beneficial. For example, the creation and utilization of resource books or guides that collate information and knowledge about teaching and training (APA, 2017) or key opportunities for BIPOC scholars (Ford and American Psychological Association Minority Fellowships, diversity supplements, conferences, relevant courses to take, and so on) could be valuable to trainees who are unaware of these opportunities as well as to the faculty and professionals who mentor and supervise them. Creative deployment of resources to support faculty members’ time, especially for those who invest in diversity initiatives in the field also could help (Galán et al. 2021). Regardless of the type of asset, sustained commitment and transparency in decision about resource allocations are key.

Climate

Climate refers to the “day-to-day dispositions (e.g., affective response, self-concept), thinking and self-perceptions within an institution” (Wood & Palmer, 2014, pp. 63–64). Most relevant to our discussion are communications, beliefs and actions that shape the institutional climate. Our colleagues identified a toxic and racist environment as a factor that negatively impacted diversity in the field. Affirming, welcoming, non-isolating, and validating climates are the goal, but unfortunately, that is not what our peers described, either through their own experiences or the observations of others’ experiences. Necessary ingredients for such climates include: perceived support from faculty and peers, high expectations for BIPOC students and faculty, and climates that are anti-racist and color conscious (Wood & Palmer, 2014). Thus, we recommend that institutions develop initiatives that foster intergroup dialogue and open communication to improve climate (Galán et al. 2021). Colleagues repeatedly identified the creation of safe spaces and opportunities to voice concerns about training and issues stemming from lack of diversity (Galán et al. 2021) as requisite elements of a diverse, equitable, and inclusive environment that could increase diversity in the field.

Partnerships

Two final domains deserve mention. First, we recommend that institutions engage in strategic partnerships that might foster diversity in clinical child and adolescent psychology. This might look like partnerships between institutional or departmental entities, local school districts, and other key sectors of the community (e.g., faith-based organizations, healthcare systems) to create opportunities for students to learn about what is needed to enter and stay in the field. Initiatives in which clinical child and adolescent trainees and professionals come to the schools or organize events that bring students to research labs or sites where clinical services are provided might provide exposure and opportunities for future clinical child and adolescent psychologists to interface with role models and get a real-life glimpse of a day in the life of a clinical child and adolescent psychologist. To the extent feasible, primary and secondary students might even be given opportunities to take part in activities that they might one day conduct or assume (e.g., presenting research findings, conducting and scoring a screening interview, etc.). In the case of research, undergraduate and graduate student labs could cultivate pathways between primary and secondary schools, college/universities, and grad schools to foster awareness of opportunities and experiences. Moreover, these partnerships and networks could cut across institutions (e.g., Hispanic Serving Institutions, historically Black colleges/Universities) to create opportunities for dialogue and the co-creation of minority youth mental health promotion initiatives (Callahan et al., 2018).

Inquiry

Finally, inquiry refers to the use of data collection and interpretation for critical evaluation of outcomes, personnel, programs and services and subsequent, iterative, data-driven decision making (Wood & Palmer 2015). In order to improve diversity in clinical child and adolescent psychology, we recommend that institutions and the field identify a clear set of agreed upon metrics and assessment tools to clarify and understand disparities and assess future progress (Buchanan et al., 2021a, 2021b). Evaluation of suggested initiatives over time will be key in assessing what works and what doesn’t. Thus, even at the program level, departments can identify a set of diversity markers or metrics (e.g., number of applications, enrollments, retention, etc.), identify barriers to success on these metrics, and then monitor progress across these metrics with the introduction of new initiatives. Moreover, the collection and use of data focusing specifically on admissions and matriculation in clinical child and adolescent graduate programs, clinical child and adolescent outcomes, programs, as well as data characterizing when people enter or leave the field could provide data that extend beyond general psychology statistics and help clarify the best investments and timing for diversifying the field. Failure to assess and collect the relevant data and or failure to report publicly (Buchanan et al., 2021) and act on the data when collected would make desired improvements in diversity in the field unlikely.

Additional ‘Change’ Reflections

The recommendations herein amplify and extend prior work, but we want to conclude with several important points. First, for change to occur, a sustained, structural, and multi-pronged strategy is needed. Discussing and talking about racism, asking questions and identifying shortcomings, creating diversity brochures, websites, or resource repositories, or new courses, or administration of semester climate surveys, in isolation, do not constitute change. Rather, sustained action is needed to foster an inclusive environment, make changes across coursework, research, and supervision (Buchanan & Wiklund, 2020), and not only administer surveys, but also analyze, disseminate, and act on the data collected. Additionally, changes that address underlying root causes of inequity (e.g., hiring underrepresented faculty, allocating resources to diversity priorities, changing policies, etc.) are likely to be most effective at producing structural changes in an organizational setting and in the field.

Second, while it is easier, relatively speaking, to generate lists of recommendations (and talk about plans for change), lists of recommendations are not analogous to critically thinking through the details and implementing the suggested changes. A major limitation of recent recommendations relating to sustained change, including our own, is that the suggestions rarely specify who should execute the proposed recommendations. As examples, in our review of the literature, departments, department chairs, and “department leadership” were tasked with reviewing syllabi, recording classes and conducting classroom observations, and a long list of action items. It is unclear who in the department should be doing this work, and even when an individual like the chair is suggested, the question of how realistic it is for one person, who likely is already quite busy, to implement suggested strategies, remains unclear. Furthermore, numerous trainings have been recommended for students and faculty, but it is not always clear who will conduct these trainings, who has the expertise to conduct the training, what resources exist to support such training, and how the training will be provided (What medium? Will it occur once or be sustained?). In the case of resource repositories (e.g., syllabi examples), who will provide guidance and the requisite expertise to assist faculty who may not have the knowledge and skills to implement necessary changes? In short, lists of recommendations is a first step, but translation and implementation of the resources is equally important and requires a collective body with responsibility for the work.

Third, there is no magic bullet or set of steps to increase diversity in the field, and one size will not fit all. Actions steps and implementation of the recommendations we and others have suggested will require careful consideration of context as what might be a great idea in one context might not work in others or cause harm in others. As an example, dialogues, role plays and conversations about racism and diversity in a setting with few racial and/or ethnic minority people could be taxing to participate in and increase vulnerability to harm for those individuals. BIPOC students are likely to have different needs as a function of their institutional contexts and as a function of their unique racial and ethnic group membership and experiences. What works for one group of students may or may not work for another group of students.

Fourth, consistent with the admonition that the change we seek requires all (and not a select few) to take responsibility and participate, we advocate that the changes we have proposed occur in a context that is attentive to power dynamics and recommend shared power and an equitable and communal approach to diversifying the field. In academic institutions, faculty, staff, and students should work collaboratively and have the power to generate and implement the desired change (rather than one person or group calling the shots with limited communication and opportunities for feedback).

Fifth, while our analysis in this essay was largely framed around training programs and research and academic institutions, some of the same challenges in these contexts (e.g., hiring, underrepresentation, hidden expectations, suboptimal mentoring) apply to other contexts (e.g., clinical child and adolescent psychologists who engage in practice and policy work) as well. Microaggressions are not exclusive to university and academic settings, and one might imagine that racism also manifests in interactions with systems like government, schools, and insurance companies. Moreover, a BIPOC provider experiencing burnout from dealing with racism in these contexts may have less bandwidth to attend to the higher needs of child and adolescent clients relative to other clinical populations (e.g., working with parents who may not get along, child protective services, working weekends and during after-school hours). Further consideration and research is needed to understand: 1) similarities and differences in how racism plays out in academic and non-academic settings with implications for when clinical child and adolescent psychologists enter the field, leave it, or are forced out (it’s not always a choice)!

Finally, while we have focused in this essay on changes to diversify the field of clinical child and adolescent psychology, we would be remiss not to take a bird’s eye view of what is at stake. Diversifying the field of clinical child and adolescent psychology can transform the questions we ask and the relevance of science for the diverse populations we serve (Buchanan & Wiklund, 2020) with implications and indirect benefits for: 1) child and adolescent mental health; and 2) equity in mental health access and treatment. BIPOC clinical child and adolescent psychologists were once children and adolescents themselves, and their lived experiences as racial and ethnic minority people in the U.S. context are likely to serve them well in clinical practice (e.g., rapport, alliance, understanding their clients’ experiences), thus enhancing youth mental health outcomes. Also, consistent with research suggesting that diversity can improve problem solving and innovation (Hewlett et al., 2013), diversifying the field can lead to the development of creative and culturally-informed, treatments, solutions, and policies, that might not otherwise emerge. Creative and culturally-informed treatments, solutions, and policies in the field will improve quality of care, with the potential to address longstanding mental health treatment disparities in access, patient satisfaction and service utilization. High quality care and equity in mental health treatment, in turn, will translate to positive mental health outcomes for BIPOC youth.

Conclusion

In this article, we have summarized a range of individual, institutional, and non-specific factors that are important to consider in understanding the lack of diversity in the field of clinical child and adolescent psychology. In the spirit of Cooke’s hope that change will come, we also offered suggestions and recommendations for how the field might advance institutional initiatives to increase workplace diversity in the field. Racism is a persistent and virulent force, informed by dimensions of power, resistance and inertia, and centering of whiteness that continue to shape who is represented and has access to the field. Yet, change is possible, even during challenging times, with action. It’s been a long time coming, and we believe change in the diversity of the field, and who will have access to it, is gonna come. Yes, it will.