James J. García, Ph.D., Assistant Professor
Maleeha T. Abbas, B.Sc., Doctoral Student
University of La Verne
The Need for a Diverse Workforce
Joaquín comes from a Mexican American family; his father, Joaquín Sr., immigrated to the U.S. as a migrant worker and was employed by the meat processing industry in the 1980’s. After 30 years working in the meat processing industry, Joaquín Sr. passed away due to a machine malfunctioning accident. This not only left his family emotionally devastated, but also financially burdened. Joaquín Jr. was left to take care of his mother and two younger sisters at the age of 30. Additional stressors on the family include an undocumented status and living in fear of deportation. Joaquín Jr., the sole earner of the family, is also trying to complete an associate’s degree from a local community college to increase his financial earning potential and improve his family’s quality of life. Lately, he has been feeling overwhelmed, and was referred to his college health center by one of his professors. His complaints included sensations of constriction in his chest, feeling angry, uncontrollable crying, intense fear of things going wrong, and constantly worrying about his assignments.
At the college health center, Joaquín met with Ali, a Clinical Health Psychology Doctoral practicum student from Pakistan. Ali and his family immigrated to the U.S. from Pakistan as refugees in the 1990’s. Ali and his parents have faced a lot of discrimination over the years, for example, people calling them terrorists, and father being denied a managerial position despite having the relevant qualifications from his home country. These discriminatory hardships, contributed to Ali’s father experiencing recurrent depressive episodes comorbid with cardiovascular disease. It is considered taboo to seek mental health treatment in Ali’s family which resulted in Ali’s father’s depression to go untreated. Ali also refrained from seeking mental health treatment as an adolescent thus, his mental and physical health suffered. In addition to Ali’s training in health psychology, he also experienced firsthand the importance of applying the biopsychosocial model of medicine in the context of his health history and family’s. Thus, during the first visit with Joaquín, Ali knew it was vital to build strong rapport to foster a sense of trust as he assessed his emotions, cultural identity, and past experiences of discrimination in relation to his mental and physical health. Carefully considering the situation of Joaquín and Ali, it is important that we as psychologists are conscious of multicultural counseling approaches to understand what it means to work with (and train those) who have life narratives and social identities different from our own.
Given the rise of diverse populations in the U.S., it is vital that we address institutional barriers in education as defined by the APA Multicultural Guidelines (see infographic below). This article will focus on racial/ethnic diversity within the context of the Health Psychology training pipeline. It is important to acknowledge that cultural, structural/institutional, and individual-level racism/discrimination have shaped the life chances of racial/ethnic people in the U.S., resulting in the development of systemic barriers to accessing quality educational opportunities and an underrepresentation of racial/ethnic people in health-related professions (including Health Psychology). Relatedly, this highlights an imperative to meet the needs of a demographically diverse U.S. population by fostering and promoting the development of a diverse workforce.
Changing Demographics Across the Country
To further understand the changing demographics of the U.S., a quick analysis of these shifts is important. The U.S Census Bureau projects the non-Hispanic White population will decrease, whereas multiracial, non-Hispanic Asians, and Hispanics will become the fastest growing population in the next several decades. More proximally, by 2020 less than half of children in the U.S. will be non-Hispanic White. This means that the U.S. population will become a majority-minority country by 2044, translating to a more racially, ethnically, and linguistically diverse population (U.S. Census Bureau, 2015). However, estimates for health occupations in the U.S. demonstrate racial/ethnic minorities are currently underrepresented in all areas of medicine. The field of Health Psychology is uniquely positioned to introspect on these changing demographics, as practitioners and researchers interact and/or provide direct patient care within the context of healthcare delivery systems. Thus, it is important to pose the question: how racially/ethnically diverse is the Psychology workforce?
Racial/Ethnic Composition of the Psychology Workforce
Findings from the broader psychology workforce indicate the field is slowly becoming more diverse, with the percentage of racial/ethnic minorities increasing from 8.9% to 16.4% and most represented at the Early Career phase (APA, 2016). Indeed, based on an independent analysis of accredited health psychology service programs over the span of 10 years, Callahan and colleagues (2018) found, compared to the representation in the U.S. population, racial/ethnic people are underrepresented in doctoral psychology training programs nationwide. Moreover, data from the APA indicate there will be an increased need (106%) for health service providers for Hispanic populations (APA, 2018). However, only 5.5% of Psychologists can provide services in Spanish and only 4.4% of psychologists are Hispanic (APA, 2016). Despite these estimates reflecting the broader Psychology workforce, it is reasonable to extend some of these findings to the field of Health Psychology.
Where can for the field of Health Psychology go from here?
Regarding the racial/ethnic composition of health psychologists, it will be important to systematically collect race/ethnicity data. This will assist in getting a “pulse” of where the profession is in terms of racial and ethnic diversity. Second, efforts to recruit a diverse health psychology workforce need to include a focus on recruitment AND retention of racial/ethnically diverse trainees to ensure proportional representation of racial/ethnic people throughout the Health Psychology training pipeline. Other divisions have tackled this daunting task. For example, Division 40 Clinical Neuropsychology has developed a subcommittee on Ethnic Minority affairs aimed at providing support to folks of color. Furthermore, Division 40 has developed partnerships with other Neuropsychological Associations (e.g., American Academy of Neuropsychology/AACN) to increase the racial/ethnic representation in their field through the “Relevance 2050 Initiative,” aiming diversify the Neuropsychology workforce by 2050. Regarding retention, there are dedicated organizations within Clinical Neuropsychology (e.g., Hispanic Neuropsychological Society) that are in the process of developing mentorship programs to link trainees to mid/senior level Clinical Neuropsychologists in the field to mentor students of color to foster the professional development and success of future racial/ethnic Clinical Neuropsychologists. Moreover, the National Academy of Neuropsychology has a dedicated committee on culture and diversity that offers a diversity award to scholars of color across the Neuropsychology training pipeline. Perhaps the field of Health Psychology may consider examining the structure and function of recruitment and retention programs to provide mentorship for future Health Psychologists of Color at different stages of the training pipeline (e.g., pre-doctoral, postdoctoral, early career). This is particularly important when working with patients like Joaquín or training graduate students like Ali.
Given the unique life narratives and experiences of racial/ethnic people and others who hold marginalized social identities, the field of Health Psychology is uniquely positioned to move beyond simply “talking” about diversity and towards taking deliberate actions to diversifying the field of Health Psychology. For example, The Society for Health Psychology instituted a Diversity Council, who seek to foster diversity-relevant issues in the society as well as promote minority health and health disparity research and good clinical practice. Moreover, the SfHP Health Research Council sponsors graduate awards to promote inclusion and health disparities. Not only do professional organizations need to actionize the APA Multicultural Guidelines, but each of us have a duty to put forth the effort in our own professional practice to meet the healthcare and training needs of diverse people like Joaquín and Ali.
American Psychological Association. (2016). 2015 APA Survey of Psychology Health Service Providers. Washington, DC: Author. http://www.apa.org/workforce/publications/15-health-serviceproviders/index.aspx
American Psychological Association. (2017). Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality. http://www.apa.org/about/policy/multicultural-guidelines.pdf
American Psychological Association. (2018). Psychologist workforce projections 2015-30. http://www.apa.org/workforce/ publications/supply-demand/default.aspx
Callahan, J. L., Smotherman, J. M., Dziurzynski, K. E., Love, P. K., Kilmer, E. D., Niemann, Y. F., & Ruggero, C. J. (2018). Diversity in the professional psychology training-to-workforce pipeline: Results from doctoral psychology student population data. Training and Education in Professional Psychology, 12(4), 273. http://dx.doi.org/10.1037/tep0000203
United States Census Bureau. (2015). New Census Bureau report analyzes U.S. population projections. https://www.census.gov/newsroom/press-releases/2015/cb15-tps16.html