PSYCH 620 Week 3 Bias, Privilege and Systemic Inequity Example

Fewer Therapy Referrals for Clients Who Need an Interpreter: Individual Bias, Systemic Inequity and What a Resettlement Agency Can Change

[Student Name]

University of Phoenix

PSYCH/620: Multicultural and Social Issues in Psychology

Week 3 Assignment

[Instructor Name]

[Date]

The agency, its referral data and staff are composites written for a model paper; research findings come from the sources listed.

Inequity is often described as the product of prejudiced individuals, but unequal outcomes can also arise from ordinary policies and practices. This paper examines a gap in my agency's own referral data and separates individual and systemic causes, with the goal of changing what produces the gap.

The Gap

Our resettlement agency in Phoenix screens adult clients for depression and posttraumatic stress symptoms at their ninety-day visit using brief, validated questionnaires administered in the client's language. Clients who score above the cutoff are supposed to be offered a referral to counseling at one of three partner clinics. I reviewed one year of records. Of 312 clients who screened positive, 118 spoke English well enough to complete the visit without an interpreter, and 194 needed one. Sixty-one percent of the English-speaking group, 72 of 118, were referred. Only twenty-eight percent of those needing an interpreter, 54 of 194, were referred. Screening scores were similar in both groups. A gap this large, among people with comparable need, called for explanation.

Terms

Some precision helps. Explicit bias is a consciously held belief or feeling about a group. Implicit bias refers to associations that may operate without awareness, often measured by reaction-time tests. Prejudice is a negative attitude; discrimination is unequal treatment. Privilege names the quiet head start that comes with belonging to a favored group, for example never once having to ask whether a clinic will speak your language. Structural or systemic inequity describes policies, resources and practices across institutions that produce unequal outcomes, whether or not anyone intends them.

Individual Factors

Individual beliefs could contribute. Staff might assume that refugees from some cultures do not want counseling, that talk therapy will not help them or that an interpreter makes counseling too awkward to be worthwhile. Such beliefs can shape judgments without hostility. Hoffman et al. (2016) surveyed white medical students and residents and found that many accepted myths about bodily differences by race, for example that Black patients have thicker skin. The more myths a trainee accepted, the lower they rated a Black patient's pain in a mock case and the less fitting their treatment plan was. The study shows that mistaken beliefs held by well-meaning professionals can translate into unequal care.

When I asked our case managers, privately, why referrals were not made, several said things like "she said she would rather talk to her imam" or "he didn't seem interested." These may reflect clients' real preferences, staff assumptions or the difficulty of explaining counseling through an interpreter during a busy visit.

System Factors

Bailey et al. (2017) reviewed how structural racism, meaning the totality of ways that societies foster discrimination through mutually reinforcing systems such as housing, education, employment, health care and criminal justice, affects health in the United States. They argued that focusing only on individual bias misses these systems, and that interventions should target policies and institutions. Their framework encourages looking at how an organization's routines, rather than only its staff, produce unequal outcomes.

At our agency, several routines stood out. The referral section of the visit form appears on the last page, after benefits and employment items; interpreted visits run longer, so case managers often reach that page with little time left. Interpreters are booked for forty-five minutes, the same as English-language visits, though interpreted visits take nearly twice as long. And two of our three partner clinics have no counselors who speak Somali, Swahili or Dari and limited access to phone interpreters, so case managers may hesitate to refer clients to services they believe the client cannot use.

No one at the agency decided that clients who need interpreters deserve less care; the schedule and the forms decided it for them.

Language Access as a System Issue

Research on language barriers in health care shows that patients with limited English proficiency who lack professional interpreters receive less information, have lower satisfaction and are at greater risk of errors, and that professional interpreters improve communication and care. When clinics lack interpreters, people who need them face delays, reliance on family members to interpret sensitive topics and, in mental health care, sessions that may never begin. Our clinic partners' limited capacity is not a matter of anyone's attitude; it reflects funding, staffing and the scarcity of counselors who speak these languages.

Can We Train Away Bias?

A common response to inequity is implicit bias training. Forscher et al. (2019) meta-analyzed 492 studies that tried to change implicit measures. Some procedures changed implicit measures, but effects were generally weak, and changes in implicit measures did not reliably produce changes in explicit attitudes or behavior. The authors concluded that changing implicit associations alone is unlikely to change behavior. This evidence suggests that a one-time training would do little to close our referral gap, though education about our own data might still help staff see the problem.

What We Can Change

The analysis points to system changes. First, move the referral section to the beginning of the ninety-day visit, so that it is completed before time runs short. Second, book interpreters for ninety minutes for interpreted visits. Third, make referral the default for every positive screen, with the client able to decline, and record declines with the reason in the client's words. Fourth, add a short, standard explanation of counseling, reviewed by community members, that interpreters can deliver in each language. Fifth, work with partner clinics to expand access to professional phone and video interpreters, and add a referral option to a community mental health program that employs a Somali-speaking counselor. Sixth, share the referral data with staff in a team meeting, framed as a system problem we can solve together.

Privilege at Our Own Desk

The concept of privilege applies to our staff as well. English-speaking clients receive their whole visit in one language, can ask follow-up questions freely and leave with a paper they can read. These advantages are not earned by the clients who hold them, and they are easy for English-speaking staff to overlook because nothing about our process feels unusual to us. Asking how each step of the visit would feel to someone who needs an interpreter is one practical way to make that privilege visible.

Measuring Progress

We will track referral rates by language group every quarter, the share of declines and reasons and the share of referred clients who attend a first appointment. The goal is to bring referral rates for clients needing interpreters within ten points of English speakers within one year.

Limits

The data come from one agency and one year. Some differences may reflect real preferences, such as preferring religious leaders for support. Defaulting to referral must respect clients' choices, not override them.

Conclusion

The referral gap at our agency illustrates how inequity can arise without intent. Individual assumptions may play a role, but forms, schedules and clinic capacity explain most of the gap. Research on structural inequity and on the limits of implicit bias training points to changes in systems, measured over time, as the most reliable path to fairer care.

References

Bailey, Z. D., Krieger, N., Agénor, M., Graves, J., Linos, N., & Bassett, M. T. (2017). Structural racism and health inequities in the USA: Evidence and interventions. The Lancet, 389(10077), 1453-1463. https://doi.org/10.1016/S0140-6736(17)30569-X

Forscher, P. S., Lai, C. K., Axt, J. R., Ebersole, C. R., Herman, M., Devine, P. G., & Nosek, B. A. (2019). A meta-analysis of procedures to change implicit measures. Journal of Personality and Social Psychology, 117(3), 522-559. https://doi.org/10.1037/pspa0000160

Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences, 113(16), 4296-4301. https://doi.org/10.1073/pnas.1516047113