DEIA in Therapeutic Programs

The principles of diversity, equity, inclusion, and accessibility (DEIA) are values espoused by most therapeutic schools and programs. At the same time, mechanisms for attaining the goals inherent in pursuing these values are complex.

Therapeutic programs, schools, and young adult transitional living situations are faced with affirming these values, developing plans to achieve the goals that these values generate, recruiting staff and students with diverse backgrounds and providing relevant professional development for them, and assuring that participants develop an openness to people who are different from themselves. Diversity may include ethnicity, economic status and background, gender identification, sexual preference, neurodiversity, and more.

Programs are grappling with these concerns in an environment inherent with obstacles, such as isolated locations and high costs of participation. Despite these obstacles, many programs are addressing these issues successfully.

To develop a more specific understanding of how therapeutic and transitional programs are dealing with DEIA issues, I interviewed Derek Daley, business development director and one of the founders of Legacy Treatment Center, Utah; Josh White, founder and executive director of Red Mountain Sedona, Arizona; Jack Hinman, executive director and co-founder of Engage Young Adult Transitions, Utah; Josh Altschule, co-founder and director, Cornerstones of Maine; and Ryan Blivas, founder of Key Healthcare, Los Angeles, California.

Jack Hinman explained that Engage is founded on the value of belonging, for which creating a sense of safety and then fostering inclusion are the first steps. Participants are invited to the table, which leads to their belonging. After that comes the possibility of connection.

Humans innately want to belong—thus programs must determine the best ways to incorporate diversity and equity as belonging and connection are facilitated. Differences can either foster or detract from inclusion and then belonging.

Engage sees belonging from the perspective of attachment and attachment styles. Inclusion can generate fear; it is important to address that and know that fear can be ameliorated by understanding one’s relational history.

If everyone in the program feels safe in the shared space, and at peace toward one another, they can explore questions that may bring up emotional issues.

Developing a safe and open therapeutic community starts at the top, and includes establishing the program’s values and goals and explaining these clearly on the website with appropriate language.

After a program establishes values of heterogeneity and acceptance, they have to be operationalized; support staff need to be caring and consistent, establishing clear expectations at the beginning of client relationships. Even though some clients may have rigid thinking patterns, it is important to openly describe the mix of people in the program and ask potential clients if they would be comfortable as part of a diverse group.

Program staff and therapists must remain curious. If someone says they don’t like something, staff would do well to explore this by asking why they feel that way and what they mean, seeking understanding.

Jack Hinman describes drawing a line in the sand: the program must create an environment of emotional safety, so if someone expresses negative feelings about others, they can’t remain in the community. Nevertheless, neurodiverse clients, for example, may initially be closed to others but may be led to see that such an approach causes problems and be able to shift their mindset.

At the same time, it is important for the program to create space for growth and allow for mistakes. A crucial part of life is managing relationship ruptures. Thus, a goal of the program is to help clients manage these ruptures; broken metal welded together is stronger than it was before. Handling ruptures effectively leads to greater safety and stronger relationships. Many things come up as participants live their lives, use media, and otherwise. It is important to help them understand the belonging piece and the need to be open to the mistakes of others. While inclusion, belonging, and connection are fostered, it helps that each person has their own bedroom and bathroom—a place to retreat.

Derek Daley describes a significant change in mindset over the years in the profession. Many founders of wilderness therapy programs came from conservative backgrounds in which people didn’t “believe in” racism. Over the years, it has become clear that racism, sexism, and other prejudices were ill-founded and since, there has been a long tradition of valuing and succeeding in creating safe spaces. Now, the diversity of those in the program is celebrated; planning for the next five years, there will be more training and internal focus challenging prejudices of staff and clients. Ethnicity, gender diversity, age, and income are all ways for diversity to be present.

The question of diversity among participants is complicated. Community-based programs and groups have not been interested in participating in our efforts to engage them and the private pay world still reflects the people who can pay for it.

Legacy has diverse clinical staff and it is helpful to have clients able to work with and relate to someone with a different experience.

In addition, staff are aware of negative language and work on challenging the group. The embracing of DEIA values is emphasized during the hiring process. Legacy also continues to emphasize being heart-centered—with a heart of love, as the Arbinger approach advocates.

Josh White of Red Mountain Sedona sees the complexity of providing treatment to diverse populations; in many cultures, parents feel shame if their child is in treatment. In addition, resources to provide access can be a problem.

Red Mountain focuses on educating clinicians and staff about DEIA and understanding what is normal in the settings from which people come. It is important to make clear that it is not the job of the “minority” to educate the program. The program must establish a culture in which people are willing to see all viewpoints and understand both infractions toward them and things that might say that insult others—even if these are unintentional.

One of the complicated aspects is creating safety but not an artificial environment, and determining what limits ensure that safety; language and physical interactions are important areas in which to set limits.

Another issue faced by Red Mountain is that in Arizona, it is illegal to intentionally pursue affirmative action.

Red Mountain continues to address the challenge of how to shed more light on what actually happens in treatment, especially in experiential programs, in order for more people to make informed treatment decisions and for access to be expanded.

Josh Altschule of Cornerstones of Maine polled his staff to discuss DEIA. They explained that they educate clients about differences, whether physical, mental, cultural, political, or otherwise, when issues arise and through regular programming. They suggest perspectives that may be different than that of the client, or some staff, in an effort to encourage clients to open their minds, understand differences, and develop acceptance and collaboration.

Understanding perspectives and motivations, or at least being able to think about perspectives and motivations that may drive another person, is part of what is helpful. Diversity among staff and clients is also sought.

His staff suggested that it would be helpful to have additional professional development experiences that go beyond typical DEI-type education, focusing on understanding cultural differences and finding common ground in a world where we all have different viewpoints, opinions, and motivations.

Ryan Blivas of Key Healthcare has expanded access to their programs by working with insurance carriers. This has created the possibility for clients of more varied backgrounds to participate, and their interactions show them that they are “all the same” in many ways. In addition, being in Los Angeles facilitates having staff of varied backgrounds, since LA is such a melting pot.

Key Healthcare works with each student to find a sense of self and get to the core of vulnerability, facing what they have been hiding from. Doing this fosters a situation in which a child who comes from a working-class background can become best friends with a well-to do peer. Gender issues are easily accepted by most teens.

Staff at Key Healthcare participate in diversity and cultural training. There is a focus on connection and community.

IEC Considerations

We need to decide whether we feel it is important for us to encourage schools and programs to strengthen their diversity, equity, inclusion, and accessibility efforts. It is certainly possible for IECs to ask programs and schools to elucidate their values and to explain what they are doing to increase their efforts in DEIA. We can look at the diversity that exists among clients and students as well as staff.

Moreover, regardless of how diverse the populations are, we can ask programs and schools to explain how they help staff and students to explore and clarify their own values. In addition, we can ask how schools and programs help students learn about people who are different from themselves and how they can therefore help students to be understanding and accepting of others.

By Cynthia Cohen, MSPH, IECA (CO)

From the Summer 2024 issue of IECA’s Insights magazine