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Conclusion When working with patients from diverse backgrounds, healthcare professionals must be willing to continuously look at personal dimensions of diversity and at how those dimensions affect their worldview and their view of their patients. Thus, mental and behavioral health professionals enter the professional relationship with a solid base of self-knowledge and a continuous commitment to critical self-reflection. They also enter into patient interactions with an open mind and curiosity regarding their patients’ lived experience, and they do not pretend to know or understand each patient’s unique combination of facets of diversity and do not assume that the patient will behave or believe in any particular way based on those facets of diversity. In fact, the culturally humble healthcare professional “cultivate(s) openness to the other person by regulating one’s natural tendency to view one’s beliefs, values, and worldview as superior, indeed, the culturally humble healthcare professional strives to cultivate a growing awareness that one is inevitably limited in knowledge and understanding of patients’ backgrounds” (Hook et al., 2016, p. 152). Resources ● Cultural Humility: People, Principles, Practices https://www.youtube.com/watch?v=_Mbu8bvKb_U&list=PL8 79555ABCCED8B50 ● National Center for Cultural Competence https://nccc.georgetown.edu ● Project Implicit https://implicit.harvard.edu/implicit/aboutus.html Agency for Healthcare Research and Quality (AHRQ). (2021). 2021 National healthcare qualities and disparities report. Pub. No. 21(22)-0054-EF . https://www.ahrq.gov/research/findings/nhqrdr/nhqdr21/index.html Š Alegría, M., Alvarez, K., Ishikawa, R. Z., DiMarzio, K., & McPeck, S. (2016). Removing obstacles to eliminating racial and ethnic disparities in behavioral health care. https://doi.org/10.1377/hlthaff.2016.0029 Š Almalky, H. (2019). Employment outcomes for individuals with intellectual and developmental disabilities: A literature review. Children and Youth Services Review https:// doi.org/10.1016/j.childyouth.2019.104656 Š American Association for Marriage and Family Therapy (AAMFT). (2015). Code of ethics. http://www.aamft. org/imis15/AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx Š References Š American Civil Liberties Union (ACLU). (2005). ACLU letter to the Senate Judiciary Committee regarding the Violence against Women Act of 2005, S. 1197. https://www.aclu.org/letter/aclu-letter-senate-judiciary- committee-regarding-violence-against-women-act-2005-s-1197> Š American Counseling Association (ACA). (2014). 2014 ACA code of ethics. https://www.counseling.org/ Resources/aca-code-of-ethics.pdf Š American Mental Health Counselors Association (AMHCA). (2015). AMHCA code of ethics. http://c.ymcdn. com/sites/www.amhca.org/resource/resmgr/Media/ethics2015FINAL.pdf Š American Psychological Association (APA). (2017). Ethical principles of psychologists and code of conduct. http://www.apa.org/ethics/code/ethics-code-2017.pdf Š American School Counselor Association (ASCA). (2016). ASCA ethical standards for school counselors. https:// www.schoolcounselor.org/getmedia/f041cbd0-7004-47a5-ba013a5d657c6743/Ethical-Standards.pdf Š Baah, F. O., Teitelman, A. M., & Riegel, B. (2019). Marginalization: Conceptualizing patient vulnerabilities in the framework of social determinants of health. An integrative review. Nursing Inquiry, 26 (1), e12268. Š Bleiweis, R., Boesch, D., & Gaines, A. C. (2020). The basic facts about women in poverty. https://www. americanprogress.org/issues/women/reports/2020/08/03/488536/basic-facts-women-poverty/ Š Bonds, A., & Inwood, J. (2016). Beyond white privilege: Geographies of white supremacy and settler colonialism. Progress in Human Geography, 40, 715-733. doi: 10.1177/0309132515613166. Š Bunch, L. (2016). America’s moral debt to African Americans. Africology: The Journal of Pan African Studies, 9 (5), 106-108. http://www.jpanafrican.org/docs/vol9no5/9.5-10 Bunch.pdf Š Byrne, A., & Tanesini, A. (2015). Instilling new habits: Addressing implicit bias in healthcare professionals. Advances in Health Science Education, 20, 1255-1262. https://doi.org/10.1007/s10459-015-9600-6. Š Carten, A. J. (2016). Introduction: The overview. In A. J. Carten, A. B. Siskind, & M. Pender Greene (Eds.), Strategies for deconstructing racism in the health and human services (pp. xxix-xxxv). Oxford University Press. Š Centers for Disease Control and Prevention (CDC). (2020). Disability impacts all of us. https://www.cdc.gov/ ncbddd/disabilityandhealth/infographic-disability-impacts-all.html Š Chung, R. C. Y., & Bemak, F. P. (2012). Social justice counseling: The next steps beyond multiculturalism. Sage. Š Cooke-Jackson, A., Rubinsky, V., Spieldenner, A., Hudak, N., Gunning, J. N., & Aragón, A. (2021). Researching marginalized populations in intimate health communication: Observations from the field. In A. Cooke-Jackson & V. Rubinsky (Eds.), Communicating intimate health (pp. 227-249). Lexington Books/Rowman & Littlefield. Š Vespa, J., Medina, L., & Armstrong, D. (2020). Demographic turning points for the United States: Population projections for 2020 to 2060. U.S. Census Current Population Reports , P25-1144. U.S. Government Printing Office. Š Davis, D. E., DeBlaere, C., Brubaker, K., Owen, J., Jordan, T. A., Hook, J. N., & Van Tongeren, D. R. (2016). Microaggressions and perceptions of cultural humility in counseling. Journal of Counseling and Development, 94, 483-493. doi: 10.1002/jcad12107 Š DeBlaere, C., Singh, A., Wilcox, M., Cokley, K., Delgado-Romero, E., Scalise, D., & Shawahin, L. (2019). Social justice in counseling psychology: Then, now, and looking forward. The Counseling Psychologist, 47 (6), 938- 962. Š Duncan, L.G. (2019). Clinical Applications of Structural Competency: A Select Bibliography. In: Hansen, H., Metzl, J. (Eds.) Structural Competency in Mental Health and Medicine. Springer, Cham. https://doi. org/10.1007/978-3-030-10525-9_18 Š Einarsen, S., Hoel, H., Zapf, D., & Cooper, C. L. (2011). The concept of bullying and harassment at work: The European tradition. In S. Einarson, H. Hoel, D. Zapf, & C. L. Cooper (Eds.), Bullying and harassment in the workplace: Developments in theory, research, and practice (2nd ed.; pp. 3-40). CRC Press. Š Equal Employment Opportunity Commission (EEOC). (2021). EEOC FY 2020 statistics: EEOC’s recovery on behalf of employees dramatically increased number of discrimination charges at all-time low. https://www. jdsupra.com/legalnews/eeoc-fy-2020-statistics-eeoc-s-recovery-9089875/ Š Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34, 165-181. https://doi.org/10.1080/02615479. 2014.977244 Š Fitzgerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18 (19). doi: 10.1186/s12910-017-0179-8 Š Florin, P. Y. (2020). What is LGBTQ discrimination? LGBT rights and laws. https://florinroebig.com/lgbtq- discrimination/ Š Foronda, C., Baptiste, D. L., Reinholdt, M. M., & Ousman, K. (2016). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27, 210-217. https://doi.org/10.1177/1043659615592677 Š Frye, M. (2019). Oppression. In T. Ball, R. Dagger, & D. O'Neill (Eds.), Ideals and Ideologies: A Reader . Routledge. https://doi.org/10.4324/9780429286827 Š Gallardo, M. E. (2014). An invitation to dialogue . . . and reflection. In M. E. Gallardo (Ed.), Developing cultural humility: Embracing race, privilege and power (pp. 1-26). Sage. Š Gates, T. (2014). Assessing the relationship between outness at work and stigma consciousness among LGB workers in the Midwest and the resulting implications for counselors. Counselling Psychology Quarterly, 27, 264-276. doi: 10.1080/09515070.2014.886998 Š Gonzalez, R. C., Biever, J. L., & Gardner, G. T. (1994). The multicultural perspective in therapy: A social constructionist approach. Psychotherapy: Theory, Research, Practice, Training, 31, 515-524. https://doi. org/10.1037/0033-3204.31.3.515 Š Gottlieb, M. (2020). The case for a cultural humility framework in social work practice. Journal of Ethnic & Cultural Diversity in Social Work, 30 (6), 463-481. doi: 10.1080/15313204.2020.1753615

This stance of openness and equality provides an environment for healthcare professionals to enter into respectful and equitable partnerships with patients. Moreover, the culturally humble clinician considers how societal structures in the U.S. serve to oppress some individuals and groups while empowering other individuals and groups. Patients are affected by the inequality within the U.S. They are affected by living in a society where racism, sexism, classism, homophobia, and discrimination based on a variety of other diverse identities, including disability and gender identity, are expressed in a multitude of ways. This discrimination obstructs access to resources and opportunities and impedes interpersonal relationships. The power imbalances within society and institutions that are experienced by patients require the culturally humble healthcare professional to take an active role in correcting those imbalances. Cultural humility challenges healthcare professionals to ask difficult questions and encourages them not to reduce patients to a preconceived set of cultural norms that have been learned in trainings about diversity and difference (Foronda et al., 2016). Finally, the culturally humble healthcare professional will engage in lifelong learning that supports effective practice. ● The Office of Minority Health, U.S. Department of Health and Human Services https://minorityhealth.hhs.gov ● Think Cultural Health https://www.thinkculturalhealth.hhs.gov Š Gruberg, S., Mahowald, L., & Halpin, J. (2020). The state of the LGBT community in 2020. https://www. americanprogress.org/issues/lgbtq-rights/reports/2020/10/06/491052/state-lgbtq-community-2020/ Š Hogh, A., Gemzoe, E., Mikkelsen, E. G., & Hansen, A. M. (2011). Individual consequences of workplace bullying/mobbing. In S. Einarsen, H. Hoel, D. Zapf, & C. Cooper (Eds.), Bullying and harassment in the workplace: Developments in theory, research, and practice (2nd ed.; pp. 107-128). CRC Press. Š Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60, 353-366. doi: 10.1037/a0032595 Š Hook, J. N., Watkins, C. E., Davis, D. E., Owen, J., Van Tongeren, D. R., & Ramos, M. J. (2016). Cultural humility in psychotherapy supervision . American Journal of Psychotherapy, 70 (2), 149-166. Š Human Rights Watch (2022). United States: Pandemic impact on people in poverty. https://www.hrw.org/ news/2021/03/02/united-states-pandemic-impact-people-poverty Š Hutchison, E. D. (2021). Dimensions of human behavior: The changing life course (6th ed.). Sage. Š Institute on Disability. (2020). 2020 annual report on people with disabilities in America. Author. Š Kosciw, J. G., Clark, C. M., Truong, N. L., & Zongrone, A. D. (2020). The 2019 national school climate survey: The experiences of lesbian, gay, bisexual and transgender youth in our nation’s schools. GLSEN. Š Lewis, D., Giga, S., & Hoel, H. (2011). Discrimination and bullying. In S. Einarsen, H. Hoel, D. Zapf, & C. Cooper (Eds.), Bullying and harassment in the workplace: Developments in theory, research, and practice (2nd ed.; pp. 267-282). CRC Press. Š Lutgen-Sandvik, P., & Arsht, S. S. (2014). How unaddressed bullying affects employees, workgroups, workforces, and organizations: The widespread aversive effects of toxic communication climates. In J. Lipinski & L. M. Crothers (Eds.), Bullying in the workplace: Causes, symptoms, and remedies (pp. 51-68). Routledge. Š Malecki, C., Demaray, M., Smith, T., & Emmons, J. (2020). Disability, poverty, and other risk factors associated with involvement in bullying behaviors. Journal of School Psychology, 78 , 115-132. https://doi.org/10.1016/j. jsp.2020.01.002. Š McIntosh, P. (1998). 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E., Wong, Y., Hamit, S., & Rasmus, M. (2014). The impact of racial microaggressions on mental health: Counseling implications for clients of color. Journal of Counseling & Development, 92, 57-66. doi: 10.1002/j.1556-6676.2014.00130.x Š Nagata, D. K., Kim, J. H. K., & Nguyen, T. U. (2015). Processing cultural trauma: Intergenerational effects of the Japanese American incarceration. Journal of Social Issues, 71, 356-370. https://doi.org/10.1111/josi.12115 Š Namie, G., Christensen, D., & Phillips, D. (2014). 2014 WBI U.S. workplace bullying survey. Workplace Bullying Institute. http://workplacebullying.org/multi/pdf/WBI-2014-US-Survey.pdf Š National Association of Social Workers (NASW). (2021). Code of ethics of the National Association of Social Workers. https://www.socialworkers.org/about/ethics/code-of-ethics Š National Conference for Community and Justice (NCCJ). (2021). Social justice definitions. https://www.nccj. org/resources/social-justice-definitions Š Obiakor, F. 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