Look at Your Blind Spots Do unconscious preconceptions shape your clinical judgment? A school-based clinician offers ways to uncover—and address—implicit bias. From My Perspective
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From My Perspective  |   November 01, 2017
Look at Your Blind Spots
Author Notes
  • Natasha Arora, MS, CCC-SLP, is a clinician at Valley Medical Center in Renton, Washington, and a research associate at the Kaiser Permanente Washington Health Research Institute in Seattle. natashaarora0@gmail.com
    Natasha Arora, MS, CCC-SLP, is a clinician at Valley Medical Center in Renton, Washington, and a research associate at the Kaiser Permanente Washington Health Research Institute in Seattle. natashaarora0@gmail.com×
Article Information
School-Based Settings / From My Perspective
From My Perspective   |   November 01, 2017
Look at Your Blind Spots
The ASHA Leader, November 2017, Vol. 22, 6-7. doi:10.1044/leader.FMP.22112017.6
The ASHA Leader, November 2017, Vol. 22, 6-7. doi:10.1044/leader.FMP.22112017.6
As a clinical fellow in a diverse public school, I collaborated with the school psychologist to determine which children qualified for our developmental preschool program.
Sandwiched between the children who clearly required speech-language services and those who did not were the many “borderline” kids: those whose scores on standardized tests were within normal limits, but whose language samples and social interaction skills indicated communication development challenges. Then there were the English-language learners for whom the limited information from parent reports and interpreters left me wondering if I was missing a piece of the puzzle.
After seeing a few students in a row who landed in this borderline zone, I started to question myself. Were my decisions consistent? Knowing about the vast educational inequities in the school district and throughout the country, I wondered if the decisions I made helped remediate or exacerbate those inequities. Were my implicit biases playing a role?
Unconscious attitudes
Implicit bias refers to attitudes or stereotypes that unconsciously affect our understanding, actions and decisions. These biases may not align with the beliefs we declare ourselves to hold. We may believe we act objectively, but we are actually influenced by biases—toward people of particular races, genders, linguistic or socioeconomic backgrounds—that pervade our society (see “Not All Bias Is Obvious—Even Our Own”).
My graduate school training emphasized the importance of cultural competence—acquiring knowledge about people of other backgrounds, asking good questions and reflecting on my own explicit beliefs. Learning about implicit bias takes this concept deeper by asking us to look at our own blind spots.
Research demonstrates that implicit bias is pervasive throughout the education and health care systems. In a 2016 Yale Child Study Center study, preschool teachers watched a video to look for problem behaviors in four children: a black boy and girl and a white boy and girl. None of the children actually exhibited problem behaviors—instead, researchers tracked the teachers’ eye movements as they watched the children in search of problem behaviors. Black and white teachers spent a disproportionate amount of time searching for problem behaviors in black boys. Although the teachers did not explicitly state a belief that black boys present with more challenging behaviors, their unconscious biases affected their perceptions of these children.
Researchers also have sought to determine the impact of race on access to educational accommodations. In a review, Ashley Yull analyzed how implicit bias may compound negative perceptions of students with autism who are also students of color. She notes that white students are more likely than black or Latino children to receive special education services under the category of autism. At the same time, black students are more likely to be labeled as intellectually disabled or emotionally disturbed, a situation that Yull attributes partly to implicit—and explicit—biases of school staff interpreting students’ behavior.

Although the teachers did not explicitly state a belief that black boys present with more challenging behaviors, their unconscious biases affected their perceptions of these children.

Reducing bias
These studies have implications for audiologists and speech-language pathologists across many settings. I think of a lively, boisterous 5-year-old on my caseload who had transferred from another school district with an IEP communication goal to reduce the volume of his voice. Was this a reasonable goal?
I wondered if this African-American child’s volume had been perceived as a problem behavior, but may have been dismissed in a child of another background. Was this the most useful and functional goal to address in our time together? There was no obvious answer to this question, but discussing these questions with my colleagues brought us all closer to an understanding of how we play a role, however small, in perpetuating or mitigating some of our school system’s inequities.
It is sobering to learn about the potential impact of implicit bias on the experiences of some of our clients, and we can play an active role in reducing our own biases. The 2012 work of researcher Patricia Devine and her colleagues helps us untangle our own biases. Participants in Devine’s “de-biasing” intervention showed reductions in implicit racial bias relative to control group participants. This intervention offers five strategies.
  • Replace stereotypes: Recognize when a response comes from a stereotype, label the response as stereotypical, and reflect on why the response occurred. Then, consider how to respond in an unbiased way in similar situations in the future.

  • Counter stereotypic imagining: Think about individuals—personal acquaintances, famous people or imaginary characters—who counter the stereotypes you hold.

  • Individuate: Obtain specific information about people, rather than simply associating them with characteristics of groups.

  • Take a different perspective: Imagine yourself as a person from a group toward which you hold biases.

  • Increase opportunities: Seek out ways to contact or engage in positive interactions with individuals from backgrounds different from our own.

Exploring our implicit biases allows us to move closer to the cultural competence needed to develop positive relationships with our clients and seek to understand their experiences.

Strengthening cultural competence
Exploring our implicit biases allows us to move closer to the cultural competence needed to develop positive relationships with our clients and seek to understand their experiences. It demands that we consider how our surroundings influence our judgments and behaviors in clinical practice and challenges us to ask difficult questions about how we might perpetuate some of the institutional biases, such as unequal disciplinary practices in schools that affect many of our clients of color.
In learning about my own implicit biases, I have encountered many more questions than answers. I still don’t know whether some of my decisions about qualifying students for developmental preschool were the right ones. I did change the IEP goals for my lively 5-year-old student, but I knew that making that change couldn’t protect him from future biases that might affect his education. However, the process of generating dialogue around bias within myself and with colleagues gives me hope that each of us can play a role in delivering more equitable services to our clients.
Take some steps to heighten your awareness of implicit bias:
  • Take the Implicit Association Test developed by Project Implicit.

  • Participate in the online “bias cleanse” developed by the Kirwan Institute for the Study of Race and Ethnicity and MTV.

  • Talk to student clinicians you teach or supervise about the concept of implicit bias, and share your experiences of learning about and countering your own implicit biases.

  • Work with other professionals in your setting to obtain training on the concept of implicit bias.

  • Encourage dialogue among colleagues. Be honest about your own experiences with bias and ask questions of others who may have a different perspective.

  • Increase your familiarity with issues surrounding racial, gender and socioeconomic inequity in the community where you practice.

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November 2017
Volume 22, Issue 11