What an IDEA! Inclusion, Diversity, Equity, and Access in the Spinal Cord Injury Community

Keywords:

• DEI
• Diversity
• Equity
• Inclusion
• Access
• Health equity
• Healthcare equity
• Spinal cord injury
• Spinal cord disease
• SCI/D
• ASCIP
• Academy of Spinal Cord Injury Professionals

Minimizing health and healthcare disparities is crucial in improving equity, individual and population health, and economic prosperity. Health disparities are “preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.”¹ They are driven by social determinants of health including, but not limited to, social, ethnic, religious, sexual orientation, gender identity, and economic factors, and understanding this is necessary to inform purposeful actions that achieve continuous progress towards Inclusion, Diversity, Equity, and Access (IDEA).

As a major professional organization in spinal cord injury and disorder (SCI/D) healthcare, the Academy of Spinal Cord Injury Professionals (ASCIP/Academy) is well-positioned to embrace and actively promote IDEA into its mission, vision, organizational functions, and educational delivery. The IDEA Committee was fostered by initial discussion by the ASCIP Advocacy Committee and was established as an Academy-level committee by the ASCIP Governance Board in January 2021 with the mission of promoting, advising, and advocating for fair, nondiscriminatory, and equitable access to opportunity, collaboration, and decision-making. The inaugural members of the IDEA Committee include: Sigmund Hough, PhD, ABPP/rp (chair), Ellia Ciammaichella, DO, JD, Anthea Gray, PsyD, Samantha Harfenist, PsyD, Trisha Hicks, LSW, MEd, Jeffrey Jaramillo, MS, DPT, Katharine Tam, MD, Florian P. Thomas, MD, PhD, and Jillian Walker, MS, OTRL, ATP. Important recognition is given to the ASCIP Governance Board for their encouragement and support. In addition, acknowledgement is given for the valuable assistance of Jeff Leonard and Amy Cheatham at The FIRM Inc.

The purpose of the IDEA Committee is to:

1. Ensure awareness and advocacy, education, and scholarship related to IDEA within ASCIP’s activities, operations, policies, communications, services, products, research, and outcome measures;

2. Establish an organizational culture where IDEA are understood, agreed upon, respected, and applied to enhance opportunities for learning and self-growth; and

3. Develop and make available pragmatic and pioneering strategies that assist in the realization of the mission statement.

In alignment with the IDEA Committee’s purpose to increase awareness and to encourage meaningful change in diversity, equity, and inclusion (DEI) as it relates to SCI/D as IDEA, the IDEA Committee is also tasked with granting an award to collaborator(s) who are working toward incorporating IDEA through scholarly work. The goal is to highlight the voices of professionals who are focused on incorporating IDEA into SCI/D patient care and to spotlight changes that are needed to ensure health equity and access. Proposals for the IDEA award are considered when an abstract for the annual ASCIP conference is submitted by the abstract deadline and marked for consideration for the IDEA award.

There are many aspects of progress with IDEA, including the elimination of explicit bias, awareness and identification of implicit bias, developing cultural competencies, and program development and implementation. Explicit biases are attitudes and beliefs that are held at the conscious level and are generally overt and are easier to identify. Thus, explicit bias can be minimized by developing awareness of the problem as well as establishing policies to minimize explicit bias in SCI/D healthcare.

Implicit bias, however, is “bias that occurs automatically and unintentionally, that nevertheless affects judgments, decisions, and behaviors.”⁶ This can be minimized by developing cultural competencies and implementing implicit bias awareness training. Recently, Centola et. al,³ provided insight into utilizing structured peer networks to exchange real-time information to improve health care decisions. They showed that clinicians who underwent independent reflection did not show any significant reduction in bias, but the clinicians who participated in peer networks significantly improved clinical accuracy and bias reduction. Despite the diversity of the interprofessional collaborative practice within medical rehabilitation, these teams are also vulnerable to the bias that affect care decisions and result in healthcare inequities.

Developing awareness is a vital first step but the IDEA Committee is also dedicated to program development and implementation of IDEA within ASCIP infrastructure as well as within SCI/D networks, institutions, and community. Incorporating IDEA within ASCIP infrastructure is fundamental in modeling IDEA within the SCI/D networks and improves IDEA dialogue between professionals. As such, the IDEA Committee has been working on improving the use of gender identity pronouns within the Academy. The IDEA Committee has also been mindful of faith and cultural traditions through inclusive scheduling when planning the ASCIP annual conference. Moreover, inclusive language has been at the forefront of the IDEA Committee’s work to ensure all feel welcome, safe and respected.

Furthermore, encouraging the development and implementation of IDEA within SCI/D networks, institutions, and community is essential in health equity. Persons with SCI/D face societal stigmatization from disability, making IDEA critically important for the SCI/D community. In a pilot study by Hausmann et al,⁴ they found that implicit racial bias of SCI/D medicine physicians was associated with worse life satisfaction, social integration, and depression. Social determinants of health significantly impact the SCI/D community and are often a barrier to social reintegration into the community, which has been a primary objective of successful rehabilitation.⁵ Thus, by applying IDEA within this realm, health equity will improve both within the SCI/D community and within the larger sphere of healthcare.

Disclosure statement

No potential conflict of interest was reported by the author(s).