Racism Undermines Quality in Human Services

Posted on May 16, 2024

By Carli Friedman, CQL Director of Research

Last month I wrote about some of the many ways ableism impacts human services – the ways it influences how we see, support, and interact with disabled people, on a daily basis. While ableism impacts human services immensely, it, like human services, does not exist in a vacuum. Racism also plays a tremendous role in how we provide services and the quality of those services. It also impacts Black, Indigenous, and people of color’s (BIPOC’s) quality of life (Friedman, 2023). The more we learn about the ways attitudes impact human services on the ground, the more we can address inequities and provide quality services to everyone. For these reasons, today we continue this journey by looking at examples of some of the ways racism impacts human services on the ground.

The data I’m sharing today comes from Basic Assurances^® (an assessment of organizational quality) conducted with 772 human service organizations that provide services to people with a variety of disabilities. I combined it with implicit race attitude data (Xu et al., 2014) from millions of people about the regions of the United States each human service organization operated in. This allowed me to examine how the racism in the regions human services organizations operate in influences their policies and practices. (All analyses control for the types of services organizations provided, the number of people they provide them to, if they operated in an urban, rural, or both geographic locations, and if the Basic Assurances^® review happened during the COVID-19 pandemic.)

What the Data Tells Us

Human service organizations who operated in regions of the United States higher in implicit racism scored lower on the Basic Assurances^® – had lower quality policies and practices overall. For example, human service organizations in regions with an average implicit race attitude of 0.2 (slightly prefer white people) had an average of 72.5 out of 92 indicators present (78.8%). In contrast, organizations in regions with an average implicit race attitude of 0.4 (moderately prefer white people) had an average of 58.9 out of 92 indicators present (64.0%). If implicit racism is eradicated altogether, organizations are expected to have 94% of indicators present – that’s really high quality services!

The Relationship Between Implicit Racism and Total Basic Assurances

Let’s look further at some more specific examples of some of the things that are impacted by racism in human services. For every 0.1 increase in implicit race attitudes in the region, the odds of

• Communication occurring among people, their support staff and their families decreased by 60.6%.
• Acute health needs being addressed in a timely manner decreased by 64.8%.
• The organization providing positive behavior supports to people decreased by 66.8%.
• The organization providing continuous and consistent services and supports for each person decreased by 68.7%.
• The physical environment promoting people’s health, safety, and independence decreased by 73.3%.

It’s not just the services that are provided to disabled people that are impacted by racism, but it also influences the ways human service organizations treat their staff as well. In fact, I found, for every 0.1 increase in implicit race attitudes in the region, the odds of organizations implementing systems that promote continuity and consistency of direct support professionals (DSPs) decreased by 66.6% and the odds of organizations treating their employees with dignity, respect and fairness decreased by 71.1%.

Probability of Staff Supports Based on Region Racism

Racism’s Influence on Human Services

In human services, we aim to help support people. But thanks to racism’s influence, without intentionality, that aim to help can actually become harmful. The attitudes of a region influence the people and organizations in the region, especially unconsciously. As long as racism continues to influence human services, services, but more importantly, disabled people’s quality of life, will suffer. Racism and quality services are incompatible.

Some of these findings may be related to the influence of how disabled BIPOC are thought about and how their behavior is interpreted. For example, there is a racial component to whose behavior is deemed “challenging,” with BIPOC’s behavior perceived to be worse (Ramey, 2019; Skiba & Williams, 2014). This likely contributes to why organizations in regions higher in implicit race attitudes were less likely to provide positive behavior supports, which are non-aversive behavior supports that focus on wider environmental causes to behavior. While problematic that racism contributes to how organizations interpret people’s behavior, it is also concerning that organizations were more likely to use aversive behavior supports, which are not only often ineffective but also harmful (Gardiner, 2017; Kupferstein, 2018; Wilkenfeld & McCarthy, 2020).

It is also important to note that most DSPs are BIPOC women (Campbell, 2017). The interplay with racism likely contributes to why organizations in regions higher in implicit rate attitudes were less likely to treat their employees with dignity and respect, and less likely to implement systems for continuity and consistency of staff. Not only does this harm DSPs, who are already vulnerable, but also disabled people, as treating staff with dignity and respect improves disabled people’s quality of life, while increased DSP turnover hinders it (American Network of Community Options and Resources, 2014; Friedman, 2018, 2021; Friedman & Gilden, in press). As such, while reducing racism should be motivation enough, an added benefit of doing so could also be reduced DSP turnover, and, by extension, improved quality of life of disabled people and DSPs.

Improving our Attitudes

The attitudes of a region influence the people and organizations in the region, especially unconsciously. When it comes to implicit attitudes, including racism, we’re like sponges – constantly absorbing everything around us, internalizing society’s messages. And just like sponges, we can start festering, getting moldy underneath the surface way before it becomes apparent to the naked eye. Once a sponge is dirty, it rubs off on everything else, often without us even realizing it. While we are products of our environments, that doesn’t mean we can’t overcome it with a little elbow grease. Like sponges, we are malleable; but unlike sponges, we can always learn, grow, and change. The best time to start or strengthen your anti-racism journey is now.

References

• American Network of Community Options and Resources. (2014). Ensuring a sustainable work force for people with disabilities: Minimum wage increases can not leave direct support professionals behind. Author. https://www.ancor.org/sites/default/files/pdf/ancor_minimum-wage-white-paper_07-11-2014.pdf
• Campbell, S. (2017). Racial and gender disparities within the direct care workforce: Five key findings. PHI. https://phinational.org/wp-content/uploads/2017/11/Racial-and-Gender-Disparities-in-DCW-PHI-2017.pdf
• Friedman, C. (2018). Direct support professionals and quality of life of people with intellectual and developmental disabilities. Intellectual and Developmental Disabilities, 56(4), 234-250. https://doi.org/10.1352/1934-9556-56.5.234
• Friedman, C. (2021). The impact of direct support professional turnover on the health and safety of people with intellectual and developmental disabilities. Inclusion, 9(1), 63-73. https://doi.org/10.1352/2326-6988-9.1.63
• Friedman, C. (2023). Ableism, racism, and the quality of life of Black, Indigenous, people of colour with intellectual and developmental disabilities. Journal of Applied Research in Intellectual Disabilities, 36(3), 604-614. https://doi.org/10.1111/jar.13084
• Friedman, C., & Gilden, C. (in press). Treating employees with dignity, respect, and fairness: The impact on the quality of life of people with intellectual and developmental disabilities. Inclusion.
• Gardiner, F. (2017). First-hand perspectives on behavioral interventions for autistic people and people with other developmental disabilities. Office of Developmental Primary Care & Autistic Self Advocacy Network. https://autisticadvocacy.org/wp-content/uploads/2017/07/First-Hand-Perspectives-on-Behavioral-Interventions-for-Autistic-People-and-People-with-other-Developmental-Disabilities.pdf
• Kupferstein, H. (2018). Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis. Advances in Autism, 4(1), 19-29. https://doi.org/10.1108/AIA-08-2017-0016
• Ramey, D. M. (2019). Punitive versus medicalized responses to childhood behavior problems and high school graduation. Sociological Perspectives, 63(2), 201-227. https://doi.org/10.1177/0731121419849094
• Skiba, R. J., & Williams, N. T. (2014). Are Black kids worse? Myths and facts about racial differences in behavior. A summary of the literature. https://indrc.indiana.edu/tools-resources/pdf-disciplineseries/african_american_differential_behavior_031214.pdf
• Wilkenfeld, D. A., & McCarthy, A. M. (2020). Ethical concerns with applied behavior analysis for autism spectrum “disorder”. Kennedy Institute of Ethics Journal, 30(1), 31-69. https://doi.org/10.1353/ken.2020.0000
• Xu, K., Nosek, B., & Greenwald, A. (2014). Psychology data from the race implicit association test on the project implicit demo website. Journal of Open Psychology Data, 2(1), e1-e3. https://doi.org/10.5334/jopd.ac