Antiracist mental healthcare training and development of multicultural awareness,knowledge and skills among school mental health providers in Canada

Abstract

In Canada, mental health disparities persist among racialized populations, including Black, Indigenous and other people of color. A major barrier to equitable care is the lack of adequate training of mental health professionals on racial issues. To address this unmet need, Cénat and colleagues introduced the Providing Antiracist Mental Health Care online training course. This contains five modules addressing: (a) awareness of racial issues, (b) assessment adapted to the needs of racialized individuals, (c) a humanistic approach to medication management, (d) treatment approaches for issues related to racism, and (e) providing tailored antiracist mental healthcare to children, adolescents, and families from racialized communities. This article discusses the implementation of this training among mental health providers in a school board in Ontario, Canada (n = 27), assessing changes in participants’ multicultural awareness, knowledge, and skills at pre-, post-, and follow-up timepoints. The results show the ability of the Providing Antiracist Mental Health Care training course to effectively enhance multicultural awareness (F(2, 21) = 10.52, p < .001), knowledge (F(2, 21) = 11.88, p < .001) and skills (F(2, 21) = 5.21, p = .014) among mental health providers in ethnically diverse schools. The total score improved significantly (F(2, 20) = 12.17, p < .001) from pre-test to post-test, and follow-up, and no significant decrement from the post-test to follow-up was observed (M = 2.81, SD = 0.16; p = .861). This study brings evidence supporting the need for sustained and comprehensive antiracist training initiatives to foster racial equity in mental health and improve outcomes in care for racialized individuals.

Keywords

mental health racism antiracism training cultural competence youth

Introduction

In Canada, as in other western countries, mental health disparities persist among racialized populations, including Black, Indigenous and other ethnic minority communities (Cénat et al., 2021b, 2025d; Chae et al., 2021; Faber et al., 2023a; Kogan et al., 2022; Miconi et al., 2021; Seaton & Carter, 2020). A significant barrier to equitable care is the lack of training of mental health professionals on racial issues. Studies have highlighted that most training programs in psychology, psychiatry, social work, counseling, and psychotherapy do not provide adequate training on racial dynamics and issues surrounding racism (Cénat et al., 2020a; Faber et al., 2023b; Sarr et al., 2022). In addition to not being trained to adequately assess and intervene with racialized people (racialized populations refer to non-White individuals who are categorized and treated based on their race or ethnicity, often in ways that result in systemic discrimination or marginalization), clinicians are not equipped to deal with the complex impacts of experiences of racial discrimination, which are highly prevalent among Black, Indigenous and people of color (BIPOC) in Canadian society (Cénat, 2023; Hemmings & Evans, 2018; Williams et al., 2022). Despite calls to action and efforts to promote diversity and inclusion in the different fields of mental health (American Psychiatric Association, 2020; American Psychological Association, 2020; Giwa et al., 2020; Jarvis et al., 2023; Kirmayer et al., 2021; Public Health Agency of Canada, 2020), much remains to be done to raise awareness, educate and equip professionals to recognize and address the complexities of racial dynamics in the provision of psychological and psychiatric care.

The negative impact of the lack of training for professionals

The lack of training for mental health professionals on racial issues has a significant effect on both the delivery of care and the well-being of racialized people. These consequences include:

Diagnostic biases. Studies have shown that gaps in the training of mental health professionals on racial issues can lead to significant diagnostic biases. Mental health professionals with little or no training in racial issues are more likely to misdiagnose or underdiagnose certain disorders (including attention deficit hyperactivity disorder, depression, anxiety, and schizophrenia) in racialized patients because of unconscious bias or cultural stereotypes (Constantine et al., 2004). They are more likely to underestimate the degree of suffering experienced by racialized clients/patients (Cénat et al., 2021a, 2022c; Kunstman et al., 2023).

Inappropriate treatment. A lack of awareness, knowledge, and skills about the links between the racial and cultural issues and dynamics surrounding the lives of racialized people and their mental health can lead to inappropriate treatment of patients (Whaley & Davis, 2007). Cultural factors and racial dynamics are very fine-grained aspects of clinical practice that psychiatrists, clinical psychologists, social workers, psychotherapists, and counselors may not know how to address in their treatment plans without adequate training, including supervised practice (Cénat et al., 2024a; Sue et al., 2019). This can lead to inappropriate care that does not meet the specific needs of racialized patients in terms of culture, language, or social context, which can compromise its effectiveness (Fernando, 2010).

Poor communication, broken trust and broken therapeutic alliance. Racialized patients may experience a lack of understanding or empathy from poorly trained and untrained mental health professionals, which can lead to miscommunication and a breakdown in trust between patient and provider (Snowden, 2001). In addition, failure to identify the specific cultural needs of racialized patients can hinder the development of a fluid and solid therapeutic alliance, which is essential to the effectiveness of mental health interventions (Constantine et al., 2004).

Racial microaggressions in care. Various studies in recent years have shown that mental health professionals who are ill-trained or untrained in racial dynamics and issues in western societies have often unintentionally perpetrated racial microaggressions against their racialized clients and patients (Williams et al., 2024). Racial microaggressions are subtle behaviors or insensitive comments that are associated with psychological harm among racialized patients (Osman et al., 2024). In addition, racial microaggressions in therapeutic settings are known to weaken the therapeutic relationship and alliance (Owen et al., 2014).

High drop-out rate before completion of care. As a result of dissatisfaction, lack of understanding or perceptions of not being heard or respected, and racial microaggressions in care provided by mental health professionals with little or no training in racial issues and dynamics, racialized people are more likely to drop-out of care prematurely, which can compromise their long-term recovery and well-being (Snowden, 2001).

Restricted access to care. The lack of racial and cultural competence among mental health professionals is a barrier to accessing care for racialized patients, preventing them from receiving the services they need for their mental health (Cénat et al., 2025b; Faber et al., 2023a; Fante-Coleman & Jackson-Best, 2020). Multicultural competence refers to the ability of mental health providers to engage effectively with diverse cultural groups by integrating awareness of one's biases, knowledge of patients’ cultural values and histories, and skills to adapt communication and care appropriately (Bhui et al., 2007; Hernandez et al., 2009; Mollah et al., 2018). It promotes inclusivity, equity, and respect, requiring ongoing learning and self-reflection in professional and interpersonal interactions (Cénat et al., 2024b; Rousseau et al., 2022). This lack of understanding of racial issues can also contribute to a mistrust of mental health services by racialized populations, delaying access to care and exacerbating mental health disparities (Snowden, 2001). Often, racialized people may be less likely to use mental health services, even when necessary, which can lead to a deterioration in their mental health and an increase in disparities in access to care and treatment (Borowsky et al., 2000). Racialized people often come to care in crisis situations, leading to increased treatment under medical and judicial duress (Cénat et al., 2024c).

The lack of training for mental health professionals thus contributes to perpetuating racial disparities in mental health and highlights the urgent need to intervene in the training and awareness of mental health professionals to guarantee equitable, quality care for all patients, regardless of their ethnic or racial origin.

Trainings in antiracist care

A recent systematic review identified antiracism training programs for mental health professionals in western countries (Cénat et al., 2024a). In total, 30 different training programs were included (22 in the United States, 4 in Canada, 4 in the United Kingdom, and 1 each in Australia and New Zealand), but only one-third (n = 10) of these programs were evaluated (Cénat et al., 2024a). This review highlighted four main areas of knowledge, skills, and competencies that are targeted by the different training programs:

Understanding the cultural, social, and historical context of mental health problems is essential. Studies highlight the importance of health professionals’ knowledge of ethnic diversity, oppression, and racism (Pieterse, 2009; Richardson et al., 2017). This includes understanding the dynamics of racism in western societies and its complex impact on the mental health of racialized people. The programs emphasize the link between mental health and the social, cultural, and economic factors that surround the lives of racialized people in minoritized contexts and the historical and intergenerational aspects of racism. Training involves experiential exercises to combat inequalities and challenge dominant narratives (Bussey et al., 2022).

Developing awareness on self-identity and privilege. Studies have highlighted the importance for mental health professionals of increasing their awareness of self-identity and privilege (Brown et al., 1996; Bussey et al., 2022; Fix et al., 2022; Ridley et al., 2000). They highlight the need for White therapists to recognize their racial positioning in society and to be aware of their identity and cultural heritage. Theoretical models have been developed to guide this process, involving confrontation with racism and discussion of multicultural issues (Liu, 2020).

Recognizing oppressive behaviors. Mental health professionals need to recognize their own conscious and unconscious biases and oppressive stereotypes and attitudes. Activities and workshops are used to raise awareness of recognizing microaggressions in the care provided (Kanter et al., 2020; Smith & Mak, 2022; Tuckwell, 2003). These studies have shown that a racially conscious approach is crucial to avoid victimization and minimize the harmful experience of racialized people in care.

Antiracist competence in therapy and alternative approaches. Studies have shown that although the other components are important for raising awareness and mobilizing mental health professionals, antiracist competence provides them with the necessary knowledge on how to establish a therapeutic relationship with racialized people (Brown et al., 1996; Cénat, 2020; Mattar, 2011). However, the most important aspect is to provide mental health professionals with the skills they need to adopt a posture that promotes the empowerment of racialized patients (Mattar, 2011; Porter, 1994; Triplett et al., 2023). This helps to avoid reproducing relations of power and White privilege within society in the therapeutic relationship. This also includes developing culturally sensitive trauma psychology programs and exploring collective and social approaches. Multicultural therapeutic skills are crucial, as is awareness of the impacts of racism when prescribing psychotropic medication (Cénat, 2020; Triplett et al., 2023). These skills should promote culturally sensitive and equitable therapeutic practices.

The Providing Antiracist Mental Health Care training course

First published in 2020 (Cénat, 2020), the Providing Antiracist Mental Health Care training course was launched in July of that year. The first version of the training contained four modules:

An awareness of racial issues. Mental health professionals must become aware of racial issues and dynamics in western societies, such as interpersonal, institutional, and systemic racism, microaggressions and internalized racism, and understand how they impact the mental health of racialized people. This also includes recognizing racial and ethnic disparities in treatment and the importance of cultural competence.

An assessment adapted to the real needs of racialized individuals. Assessments should be tailored to the specific needs of racialized individuals, taking into account their unique cultural backgrounds and the intergenerational impacts of slavery, colonization, and historic and systemic racism. This involves understanding the broader social, economic and racial context, dynamics, and disparities affecting the mental health of racialized people. The module provides different tools and measures to understand and assess complex racial trauma with a lifelong perspective (Cénat, 2023).

A humanistic approach to medication. Racialized people are more likely to be overmedicated for mental illness and to receive coercive psychiatric treatment, but are less likely to adhere to medication for mental disorders (Faber et al., 2023c; Knight et al., 2021, 2023). This module examines the justified mistrust that racialized people have in medical bodies in general and in mental health prescribers particularly (Cénat et al., 2024c; Faber et al., 2023c). Indeed, medication should only be prescribed when no alternatives are available. More importantly, physicians must clearly explain the purpose, benefits, and potential side effects of medications to ensure informed consent. Self-reflection is an important continuous process to maintain a humanistic approach in medication management and prevent the over-prescription often observed among racialized patients in North American and European countries (Cénat et al., 2023). This approach will participate in building trust in mental health-related professions in general.

A treatment approach that addresses the real needs and issues related to racism experienced by racialized individuals. Treatment should directly address the experiences of complex racial trauma and its impact at different levels of the life of racialized individuals in western countries. Providers should use culturally and racially appropriate interventions. They are encouraged to admit their limitations in understanding their clients’ experiences and avoiding racial microaggressions in a therapeutic context while committing to antiracist care.

Another module covering the specific nature of the care provided to children, adolescents and families was also developed into a final version with five separate modules (Cénat et al., 2020b, 2025a):

Providing tailored antiracist mental healthcare to children, adolescents, and families from racialized communities. Providing tailored antiracist mental healthcare to racialized children, adolescents, and families involves understanding their cultural backgrounds, conducting individualized assessments, and addressing racial trauma and systemic discrimination that surrounds parental education and relationship dynamics with mental health structures and care (Cénat et al., 2025c). It requires working collaboratively with families, fostering children and adolescents’ resilience to navigate our racist system, and implementing culturally relevant interventions. Building trust and promoting advocacy within the healthcare system is also crucial to effectively support the mental health needs of racialized youth and families.

Since then, the course has been taken by several thousands of mental health professionals around the world via the https://mentalhealthforeveryone.ca/ platform and is accredited by the Canadian Psychological Association. However, it has never been formally evaluated. Hence the aim of this article is to evaluate the Providing Antiracist Mental Health Care training course to equip mental health professionals to develop cultural competence. Cultural competence constitutes a critical antiracist skill because it facilitates the recognition and deconstruction of personal biases, while fostering an understanding of and respect for diverse cultural contexts (Constantine & Sue, 2006; Sue & Torino, 2004). The development of cultural competence enables psychiatrists, psychologists, psychotherapists, and mental health providers to engage effectively with racially diverse populations, promote inclusive environments, address systemic inequities that perpetuate racism, and eliminate racism in care (Cénat et al., 2024b; Sue & Torino, 2004). Beyond mere acknowledgment of cultural differences, cultural competence involves leveraging this awareness to challenge discriminatory practices, thereby ensuring equitable treatment of individuals by integrating aspects related to their racial or cultural backgrounds (Cénat et al., 2024b; Constantine & Sue, 2006; Sue & Torino, 2004).

Methods

Procedure

A group of master's level social workers and mental healthcare providers in a school board in Ontario (Canada) received training in ‘providing antiracist mental healthcare.’ The school board is ethnically diverse, with students from BIPOC communities. As a reminder, Ontario is the most ethnically diverse province in Canada, which contains people from more than 450 different ethnic origins (Statistics Canada, 2022). The social workers first received the training materials, consisting of a manual and a Power Point presentation for each module. Then, two days of workshops of 6 h each were devoted to presentations by four different professionals, including two clinical psychologists with more than 10 years of experience on these issues, a senior doctoral student in clinical psychology and a specialist in mental health in the workplace. In addition to the presentation of the training content, clinical cases involving assessment and intervention were discussed. Following the training, three clinical supervision sessions were organized over a period of 6 months to facilitate the integration of the content. The social workers were assessed 2 weeks before the training, 2 weeks after the training and 8 months afterwards. The training was attended by 29 participants, 2 of whom did not complete the pre-test questionnaire and were not eligible to take part in the other two measurement periods. Figure 1 provides details of the training implementation design, process, and evaluation times. All mental health providers gave their informed consent to participate. The study protocol was approved by the Research Ethics Board of the University of Ottawa. A previous publication described the whole process of the research (Cénat et al., 2025a).

Figure 1.

Research design of the implementation and assessment of the ‘Providing Antiracist Mental Health Care’ training.

Participants

In total, 27 participants (M age = 36.44, SD = 7.44) completed the pre-test outcome variable. Twenty-two (81.48%) participants were women, four (14.81%) participants were men, and one (3.70%) participant identified as non-binary. Eighteen participants were White (66.67%), and nine participants (33.33%) were from racialized groups. Seventeen (62.96%) participants spoke English or French at home, eight (29.63%) participants were bilingual and two (7.41%) spoke another language at home. Nineteen participants (76%) were born in Canada. Of the 27 participants, 22 completed the assessments after the training course and 20 completed the follow-up 8 months later. In total, 18 participants completed the three waves of assessment. Sample characteristics are presented in Table 1.

Table 1.

Mean (SD) of total score by sociodemographic factors over pre–post-test and follow-up.

	Time 1		Time 2		Time 3		Complete 3 times		Total score			Statistical testsF(df1, df2), p-value
	N †	% ‡	N †	% ‡	N †	% ‡	N †	% ‡	Pre-testM (SD)	Post-testM (SD)	Follow-upM (SD)	Statistical testsF(df1, df2), p-value
Total	27		22		20		18		2.59 (0.26)	2.79 (0.22)	2.81 (0.16)	F(2, 20) = 12.17, p < .001
Age §												F(5, 22) = 4.84, p = .004
Below mean	14	51.85	10	45.45	10	50.00	9	50.00	2.61 (0.24)	2.80 (0.27)	2.81 (0.18)	F(2, 9) = 9.60, p = .006
Above mean	13	48.15	12	54.55	10	50.00	9	50.00	2.56 (0.28)	2.78 (0.18)	2.80 (0.13)	F(2, 8) = 6.06, p = .023
Gender												F(6, 21) = 5.37, p = .002
Men	4	14.81	3	14.29	3	15.79	3	16.67	2.63 (0.30)	2.87 (0.14)	2.72 (0.12)
Women	22	81.48	18	85.71	16	84.21	15	83.33	2.58 (0.26)	2.80 (0.22)	2.83 (0.16)	F(2, 17) = 10.54, p = .001
Other	1	3.70
Race												F(5, 22) = 6.65, p < .001
White	18	66.67	14	66.67	12	63.16	11	61.11	2.54 (0.24)	2.82 (0.20)	2.85 (0.16)	F(2, 11) = 15.29, p < .001
Racialized	9	33.33	7	33.33	7	36.84	7	38.89	2.68 (0.28)	2.80 (0.22)	2.76 (0.15)	F(2, 7) = 1.15, p = .370
Language spoken at home												F(5, 21) = 7.22, p < .001
Only English or French	17	62.96	15	71.43	14	73.68	14	77.78	2.55 (0.27)	2.84 (0.19)	2.80 (0.15)	F(2, 13) = 13.77, p < .001
Bilingual	8	29.63	5	23.81	4	21.05	3	16.67	2.69 (0.24)	2.81 (0.15)	2.94 (0.09)
Other	2	7.41	1	4.76	1	5.26	1	5.56
Place of birth												F(5, 19) = 6.76, p < .001
Canada	19	76.00	16	80.00	14	77.78	13	76.47	2.54 (0.23)	2.83 (0.20)	2.83 (0.16)	F(2, 13) = 17.50, p < .001
Abroad	6	24.00	4	20.00	4	22.22	4	23.53	2.69 (0.32)	2.86 (0.10)	2.83 (0.11)	F(2, 4) = 2.74, p = .182
Marital status												F(8, 20) = 3.22, p = .016
Single	8	29.63	6	28.57	6	31.58	5	27.78	2.62 (0.30)	2.82 (0.13)	2.82 (0.18)	F(2, 5) = 4.27, p = .081
Married	10	37.04	9	42.86	9	47.37	9	50.00	2.61 (0.23)	2.85 (0.25)	2.84 (0.14)	F(2, 8) = 8.02, p = .011
Other (separated/widowed/other)	9	33.33	6	28.57	4	21.05	4	22.22	2.53 (0.26)	2.74 (0.21)	2.76 (0.18)	F(2, 6) = 2.92, p = .126

† Some variables do not reach total N due to missingness.

‡ Valid percentages were reported.

§ Age was standardized, and then categorized based on the mean.

Measures

Sociodemographic information

Participants completed a sociodemographic questionnaire that assessed various characteristics such as age, gender, racial/ethnic background, language spoken, place of birth, and marital status.

Multicultural Awareness, Knowledge, and Skills Survey

The outcome variable was multicultural awareness, knowledge, and skills and was measured using the Multicultural Awareness, Knowledge, and Skills Survey (MAKSS; D’Andrea et al., 1993). The MAKSS is a 60-item scale measuring multicultural awareness (e.g., ‘Culture is not external but is within the person’), multicultural knowledge (e.g., ‘Differential treatment in the provision of mental health services is not necessarily thought to be discriminatory’), and multicultural skills (e.g., ‘How would you rate your ability to accurately assess the mental health needs of women?’). Each subscale contains 20 items. Participants were asked to respond to each statement on a Likert-scale point from ‘very limited’ or ‘strongly disagree’ to ‘very good’ or ‘strongly agree’. For each subscale, scores on each item were summed and then divided by 20 according to the number of items (D’Andrea et al., 1993). The total score was also calculated by summing up the mean scores of each subscale and dividing by three. The Cronbach's alpha for awareness, knowledge, and skills subscales was .72, .85, and .87, respectively. Cronbach's alpha for this scale was .91 in the current study.

Statistical analysis

Mean (M) and standard deviation (SD) of the outcome variables were reported for pre-test, post-test, and follow-up. The mean of the results for these variables (pre-test, post-test, and follow-up) were plotted. A linear mixed model for repeated measures was performed to examine the effect of the program on the outcome variables. Unstructured repeated covariance was used for repeated measure analysis. Because there were missing observations for some of the participants at one or two timepoints, the restricted maximum likelihood estimation (REML) method was applied. Follow-up analyses were performed to test the mean differences from pre-test to post-test and post-test to follow-up using the least significant difference test. Moreover, a set of follow-up analyses on the only interaction effects based on sociodemographic factors were conducted. Within-group differences for each sociodemographic group were also tested. The analyses were performed for the entire score of the MAKSS and for each subscale: multicultural awareness, multicultural knowledge, and multicultural skills. A significance level of .05 was used for all statistical analyses. All analyses were conducted in SPSS 29.

Results

Changes in the total score of the MAKSS and the scores of each subscale (multicultural awareness, knowledge, and skills) are presented in Table 1. The total score improved significantly (F(2, 20) = 12.17, p < .001) (Figure 2). To examine the differences from pre-test to post-test, and post-test to follow-up, a set of post-hoc analyses was conducted. This analysis indicated a significant increase from the pre-test (M = 2.59, SD = 0.26) to the post-test (M = 2.79, SD = 0.22) in total scores (p < .001), and no significant decrement from the post-test to follow-up (M = 2.81, SD = 0.16; p = .861). Regarding the effect of sociodemographic factors on the total score changes, a significant interaction effect for age (p = .004), gender (p = .002), race (p < .001), language spoken at home (p < .001), place of birth (p < .001), and marital status (p = .016) was observed. Follow-up analyses on the total score changes within each group are presented in Table 1. The same pattern of score changes was found among participants who were aged below and above mean, among women, White, married, participants who were born in Canada and those who spoke only English or French at home (Table 1). In general, no significant differences between pre-test, post-test, and follow-up in the total score were observed among racialized groups, single individuals, and those with other marital status.

Figure 2.

Changes in multicultural awareness, knowledge, and skills survey total and subscales scores.

In terms of subscale scores, the awareness subscale changed significantly (F(2, 21) = 10.52, p < .001) (Figure 2). Post-hoc analysis showed a significant increase from pre-test (M = 2.60, SD = 0.20) to post-test (M = 2.75, SD = 0.20) in awareness scores (p < .001), and no significant changes from post-test to follow-up (M = 2.73, SD = 0.21; p = .481).

Results showed that the scores for the knowledge subscale changed significantly (F(2, 21) = 11.88, p < .001) (Figure 2). Post-hoc analysis showed a significant increase from pre-test (M = 2.54, SD = 0.35) to post-test (M = 2.82, SD = 0.33) in knowledge scores (p < .001), and no significant change from post-test to follow-up (M = 2.82, SD = 0.19; p = .678).

Moreover, significant differences for the skills subscale were observed (F(2, 21) = 5.21, p = .014) (Figure 2). Post-hoc analysis showed a significant increase from pre-test (M = 2.61, SD = 0.37) to post-test (M = 2.78, SD = 0.32) in skills scores (p = .010), and no significant change from post-test to follow-up (M = 2.89, SD = 0.26; p = .373). To test changes in the scores of subscales between sociodemographic groups, a series of interaction analyses followed by a set of follow-up analyses within sociodemographic groups were conducted. The results are presented in Table 2.

Table 2.

Mean (SD) of subscales by sociodemographic factors over pre-post-test and follow-up.

	Awareness			Statistical testF(df1, df2), p-value	Knowledge			Statistical testF(df1, df2), p-value	Skills			Statistical test
	Pre-testM (SD)	Post-testM (SD)	Follow-upM (SD)	Statistical testF(df1, df2), p-value	Pre-testM (SD)	Post-testM (SD)	Follow-upM (SD)	Statistical testF(df1, df2), p-value	Pre-testM (SD)	Post-testM (SD)	Follow-upM (SD)	F(df1, df2), p-value
Total	2.60 (0.20)	2.75 (0.20)	2.73 (0.21)	F(2, 21) = 10.52, p < .001	2.54 (0.35)	2.82 (0.33)	2.82 (0.19)	F(2, 21) = 11.88, p < .001	2.61 (0.37)	2.78 (0.32)	2.89 (0.26)	F(2, 21) = 5.21, p = .014
Age				F(5, 23) = 4.58, p = .005				F(5, 22) = 5.32, p = .002				F(5, 24) = 2.46, p = .062
Below mean	2.61 (0.22)	2.75 (0.22)	2.77 (0.24)	F(2, 9) = 4.13, p = .051	2.55 (0.30)	2.79 (0.33)	2.75 (0.20)	F(2, 8) = 34.82, p < .001	2.67 (0.40)	2.86 (0.42)	2.93 (0.34)	F(2, 7) = 3.62, p = .082
Above mean	2.59 (0.18)	2.75 (0.19)	2.68 (0.18)	F(2, 11) = 11.98, p = .002	2.53 (0.41)	2.85 (0.34)	2.88 (0.18)	F(2, 8) = 5.29, p = .033	2.55 (0.34)	2.75 (0.17)	2.85 (0.16)	F(2, 10) = 3.23, p = .082
Gender				F(6, 22) = 4.15, p = .006				F(6, 22) = 4.39, p = .005				F(6, 22) = 1.96, p = .115
Men	2.59 (0.15)	2.78 (0.18)	2.60 (0.13)		2.65 (0.49)	2.97 (0.10)	2.72 (0.21)		2.66 (0.35)	2.87 (0.16)	2.83 (0.12)
Women	2.60 (0.21)	2.75 (0.21)	2.76 (0.23)	F(2, 17) = 7.48, p = .005	2.52 (0.34)	2.84 (0.31)	2.83 (0.20)	F(2, 18) = 12.06, p < .001	2.61 (0.31)	2.81 (0.32)	2.91 (0.28)	F(2, 16) = 4.77, p = .023
Race				F(5, 21) = 7.40, p < .001				F(5, 24) = 5.25, p = .002				F(5, 22) = 3.16, p = .026
White	2.57 (0.20)	2.74 (0.17)	2.80 (0.22)	F(2, 12) = 10.28, p = .002	2.48 (0.32)	2.86 (0.30)	2.79 (0.19)	F(2, 14) = 8.94, p = .003	2.57 (0.37)	2.85 (0.33)	2.95 (0.30)	F(2, 11) = 13.99, p < .001
Racialized	2.68 (0.19)	2.78 (0.26)	2.62 (0.18)	F(2, 7) = 9.44, p = .011	2.66 (0.41)	2.86 (0.29)	2.86 (0.22)	F(2, 7) = 2.78, p = .129	2.69 (0.37)	2.74 (0.24)	2.81 (0.16)	F(2, 7) = .66, p = .545
Language spoken at home				F(5, 20) = 5.22, p = .003				F(5, 22) = 5.14, p = .003				F(5, 22) = 4.97, p = .003
Only English or French	2.58 (0.21)	2.75 (0.20)	2.74 (0.24)	F(2, 13) = 8.04, p = .005	2.50 (0.37)	2.86 (0.27)	2.78 (0.20)	F(2, 14) = 7.41, p = .006	2.56 (0.35)	2.90 (0.30)	2.88 (0.22)	F(2, 13) = 13.08, p < .001
Bilingual	2.68 (0.17)	2.85 (0.04)	2.80 (0.04)		2.63 (0.35)	2.94 (0.32)	2.96 (0.17)		2.75 (0.44)	2.66 (0.16)	3.05 (0.36)	F(2, 4) = 3.94, p = .119
Place of birth				F(5, 19) = 5.66, p = .002				F(5, 22) = 5.91, p = .001				F(5, 20) = 3.92, p = .012
Canada	2.59 (0.20)	2.75 (0.17)	2.77 (0.22)	F(2, 14) = 8.01, p = .005	2.49 (0.33)	2.86 (0.28)	2.79 (0.19)	F(2, 16) = 9.68, p = .002	2.55 (0.33)	2.87 (0.32)	2.93 (0.28)	F(2, 12) = 17.53, p < .001
Abroad	2.70 (0.20)	2.88 (0.21)	2.69 (0.19)		2.66 (0.42)	2.98 (0.24)	2.94 (0.23)	F(2, 4) = 4.98, p = .077	2.71 (0.46)	2.74 (0.09)	2.88 (0.13)	F(2, 3) = 48.13, p = .002
Marital status				F(8, 20) = 3.09, p = .019				F(8, 22) = 3.49, p = .009				F(8, 19) = 1.85, p = .129
Single	2.68 (0.23)	2.80 (0.19)	2.72 (0.14)	F(2, 6) = 11.08, p = .009	2.53 (0.35)	2.93 (0.27)	2.83 (0.24)	F(2, 5) = 11.73, p = .013	2.66 (0.49)	2.73 (0.15)	2.91 (0.33)	F(2, 4) = 1.76, p = .281
Married	2.60 (0.18)	2.77 (0.22)	2.73 (0.25)	F(2, 8) = 5.68, p = .029	2.59 (0.36)	2.84 (0.30)	2.87 (0.16)	F(2, 9) = 4.66, p = .042	2.63 (0.31)	2.94 (0.37)	2.92 (0.27)	F(2, 8) = 7.68, p = .013
Other (separated/ widowed/other)	2.54 (0.19)	2.69 (0.18)	2.75 (0.29)	F(2, 5) = 4.37, p = .075	2.50 (0.38)	2.81 (0.32)	2.68 (0.19)		2.56 (0.35)	2.71 (0.28)	2.85 (0.16)	F(2, 5) = 2.19, p = .205

Discussion

The main objective of this study was to assess implementation of the training program ‘Providing Antiracist Mental Health Care’ and its ability to improve the multicultural competence of mental health professionals providing care in ethnically diverse schools in Ontario, Canada. The results indicate significant improvements in multicultural competence through the MAKSS, which is the most used scale to evaluate training programs with similar objectives (Lenes et al., 2020; Robb, 2014). In fact, the total score on the MAKSS increased significantly. Specifically, the MAKSS total score showed a notable increase from pre-test to post-test, with no significant decrease at follow-up, indicating stable gains in knowledge 8 months after participants had taken the training. These findings suggest that the training effectively enhances cultural competence and sustains improvements in multicultural awareness, knowledge, and skills over time. The observed stability in multicultural competence scores post-training may be attributed to the comprehensive and practical approach of the training program, which emphasizes ongoing reflection on racial dynamics and relations, and the application of antiracist principles and practices. In addition, the focus on real-life scenarios of racialized people and interactive components likely reinforced the retention of knowledge and skills.

In a recent systematic review, it was found that training courses that address awareness of the impact of racism on mental health, racial dynamics and relations in assessment and intervention (psychotherapy and medication), although less comprehensive than the current training, facilitate the development of multicultural competence (Cénat et al., 2024a). However, some studies showed that gains in multicultural competence tend to decrease over time (Delphin-Rittmon et al., 2013; Truong et al., 2014), which is not the case in the current study. These factors revealed in this systematic review (Cénat et al., 2024a) are known to help clinicians develop antiracist attitudes while providing care, and solidify alliances with clients/patients through understanding and recognizing racial and cultural dynamics, fostering respect, and reducing biases (Betancourt, 2004; Lenes et al., 2020). They also contribute to the development of antiracist attitudes and ethnic and cultural sensitivity by addressing systemic inequalities and reducing and/or eliminating racial microaggressions and discrimination in the provision of care (Boyer et al., 2019). Building cultural competence enhances trust and solidifies the therapeutic alliance between clinicians and patients, leading to improved engagement and outcomes (Boyer et al., 2019; Sue et al., 2019; Vega et al., 2018).

The results also reveal that improvements varied according to gender. Men reported a higher score in multicultural competence at pre-test compared with women, which might be attributed to higher personal confidence levels. Men also demonstrate greater immediate improvement in multicultural competence at the post-test stage. However, women demonstrated better retention and maintenance of multicultural competence at the follow-up stage, suggesting a deeper internalization of the training principles and a better ability to apply their knowledge and skills in therapeutic relationships with racialized students in an ethnically diverse context. Research suggests that women may engage more deeply with reflective and integrative learning practices, leading to better long-term retention (King et al., 2010). In addition, women's better maintenance of competence may be linked to higher levels of empathy and interpersonal sensitivity, facilitating sustained application of multicultural principles (Miville et al., 2006).

The results also showed that at the baseline (pre-test), racialized mental health professionals report higher levels of multicultural competence than their White counterparts. This may be attributed to their personal experiences, greater interest, and a deeper understanding of racial and cultural dynamics in Canadian society. However, the results also indicate that White mental health professionals show greater improvement and maintenance of multicultural competence following training compared with their racialized counterparts. This interesting result may be explained by the fact that in ethnically diverse mental healthcare teams, racialized clients/patients’ cases are usually assigned to racialized professionals. White professionals may have fewer opportunities to interact with racialized patients, whereas racialized professionals are exposed to vicarious racial trauma (Cénat et al., 2022a, 2022b). In addition, in the specific case of this study conducted with school mental health providers, racialized professionals frequently handle complex cases involving racism, leading to vicarious trauma and feelings of powerlessness (Anthym & Tuitt, 2019; Hargons et al., 2022; Williams et al., 2021). The racism to which racialized youth are exposed in schools can also remind them of their own experiences of racial discrimination and those of their own children and young relatives. In this situation, interpersonal racism from colleagues, school staff and direction, parents and students, and institutional racism may also impact their perceived multicultural competence and emotional resilience (Harrell, 2000).

The study also highlights that bilingual mental health professionals report higher levels of multicultural competence than their monolingual counterparts. In addition, bilingual professionals maintain their competence better over time. This can be attributed to the fact that language competence inherently involves understanding and navigating multiple cultural contexts (Sue & Sue, 2016).

Implications for practice, training, and research

The positive outcomes from this training appear to be beneficial to participants and provide an avenue whereby school mental healthcare providers can learn to better meet the needs of racialized students. This training can be incorporated into antiracist education programs within college and university curricula for mental health professionals. Institutions providing mental healthcare (e.g., hospitals, community mental health services, schools) can also implement antiracist training to help ensure that each mental health professional working in their service has the necessary multicultural competence to provide antiracist mental healthcare. Ensuring that such training is an integral part of continuous education could help maintain high levels of cultural competence and mitigate the impact of everyday racial discrimination experiences in mental healthcare. Further research should explore the long-term benefits and scalability of such training programs across different settings and populations.

In terms of clinical practice, it is important that racialized mental health professionals are not unduly burdened with treating all the racialized students, because this overload can contribute to vicarious racial trauma and burnout. Hence the importance of training all mental health professionals and not always assigning racialized patients to racialized professionals. This study also shows the importance of implementing the ‘Providing Antiracist Mental Health Care’ program among mental health clinicians to assess its ability to help them to develop multicultural competence. Future studies are needed to assess other aspects of care such as the therapeutic alliance with racialized clients. Studies can also evaluate the experience of patients before and after their clinicians were trained to determine whether the competence acquired positively impacts their practice in the view of the racialized patients, in respect to ethical considerations. We also need to investigate how personal experiences with racism and cultural immersion influence resilience and multicultural competence.

Limitations

Although this is an important study, it does have some limitations that are worth noting. First, the sample remains small, and a larger sample would have enabled more in-depth analyses. Although the vast majority of studies have been carried out with small samples, future studies need to collect data from larger samples to better analyze the changes. Second, the sample is relatively homogenous with participants with similar educational backgrounds and professions (all social workers with a master's degree and working for the same school board). While having some advantages, it limits the possibility of seeing the effect of training on different groups. This will be an important exercise to carry out with clinical psychologists, psychiatrists, and psychotherapists to see if differences exist. Finally, the use of self-reported measures remains a limitation, given the sensitivity of the subject being explored and the social desirability that may ensue. Future studies might evaluate outcomes using observational methods and student feedback.

Conclusions

The insights brought by this article indicate that the ‘Providing Antiracist Mental Health Care’ training program effectively enhances multicultural awareness, knowledge and skills among mental health providers in ethnically diverse schools in Ontario, Canada. Through its scientific-based approach and five comprehensive modules tailored to the real experiences and needs of racialized populations in western countries (awareness of racial issues; assessment adapted to the real needs of racial individuals and their experiences of different levels of racism; a humanistic approach to medication; a treatment approach that addresses the real needs and issues related to the racism experienced by racialized individuals; and a tailored care responding to the real needs of racialized children, adolescents and families), it helps clinicians develop necessary antiracist competence and attitudes. It shows it is possible to ensure that all clinicians, regardless of their gender, racial background, or country of origin are well-equipped to deliver culturally competent, sensitive, effective and antiracist mental healthcare. In conclusion, these results contribute to the growing body of evidence supporting the need for sustained and comprehensive antiracist training initiatives to foster equity and improve outcomes in mental healthcare for racialized individuals.

Footnotes

Acknowledgements

We wish to acknowledge Wina Darius, Cathy Broussard and Léa Gakima for the coordination role within the Interdisciplinary Centre for Black Health and the Vulnerability, Trauma, Resilience, and Culture Research Laboratory.

Contributors

The authors contributed equally performing analyses, drafting, and revising the article. JMC obtained fundings from the Social Sciences and Humanities Research Council (SSHRC) and the Canadian Institutes of Health Research (CIHR).

Data availability

The data are not publicly available due to privacy and ethical restrictions. They are available on request from the corresponding author.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

This article was supported by the grant #469050 from the Social Sciences and Humanities Research Council (SSHRC) and Canadian Institutes of Health Research (CIHR) and the grant # 4500440446 from the Public Health Agency of Canada (PHAC) and Social Sciences and Humanities Research Council of Canada (grant number 1036-2021-00702). The funders were not involved in the design, and interpretation/writing the paper.

ORCID iDs

Jude Mary Cénat

Monnica Williams

Author biographies

Jude Mary Cénat, PhD, MSc, CPsych, is a registered clinical psychologist and full professor at the School of Psychology, Director of the Interdisciplinary Centre for Black Health and the Vulnerability, Trauma, Resilience and Culture Research Laboratory (V-TRaC Lab) at the University of Ottawa. He also holds the University of Ottawa Research Chair on Black Health. His research program explores factors associated with vulnerability, trauma, and resilience, with a particular interest in the role of cultural factors, racial disparities in health and social services, and global mental health. He conducts research in North America, Europe, Africa, and the Caribbean. He leads major projects on the mental health of Black communities in Canada, documenting for the first time the prevalence and related factors of depression, anxiety, post-traumatic stress disorder, psychosomatic symptoms, and other mental health issues among Black people in Canada. With his team, he has also developed online trainings (through the bilingual platform https://santementalpourtous.ca / ) aimed at equipping mental health professionals to provide culturally responsive and anti-racist care. Dr Cénat is also a member of the College of New Scholars, Artists and Scientists of the Royal Society of Canada.

Mahdi Moshirian Farahi received his PhD in cognitive psychology from Carleton University in 2024. He is currently a CIHR postdoctoral fellow at the University of Ottawa, where he contributes to the Vulnerability, Trauma, Resilience, and Culture Research Laboratory (VTRaC-lab). Dr Moshirian Farahi's current research centers on the neuroscience of racism, with a particular focus on how experiences of racial discrimination affect brain development and structures and mental health among racialized populations. He uses functional magnetic resonance imaging and advanced statistical modeling to examine the neural correlates of racial discrimination. In addition to his neuroimaging work, he studies the psychosocial determinants of mental health, especially stress and anxiety, and investigates the prevalence and contributing factors of developmental disorders among racialized communities in Canada.

Rose Darly Dalexis is a PhD candidate in population health in the Interdisciplinary School of Health Sciences at the University of Ottawa. Her research focuses on workplace racial discrimination and its impact on health, with broader interests in population health, occupational health and safety, and health disparities. Her work has been recognized with numerous prestigious awards, including the Three Councils Scholarship (SSHRC, CIHR, NSERC) and the Ontario Graduate Scholarship.

Cary Kogan is a full professor of clinical psychology at the University of Ottawa and a registered clinical psychologist. Professor Kogan was a consultant to the World Health Organization for training and implementation of the 11th revision of the International Classification of Diseases (ICD-11) for mental, behavioral and neurodevelopmental disorders. His interdisciplinary research program spans the several topics including mental health classification, understanding the detrimental impact of racism on the mental health of people from the Black Canadian communities, and investigating the negative effects of antisemitism on faculty members’ mental health.

Pari-Gole Noorishad, BA Hons is a PhD candidate in clinical psychology at the University of Ottawa. Her published research focuses on mental health, cultural psychology, and human sexuality. She has a particular interest in how culture, identity, and intersectionality shape psychological well-being and sexual health outcomes. In addition to her research, Pari-Gole is involved in clinical service, with a commitment to integrating research and practice to address the needs of minoritized populations.

Monnica T. Williams is a board-certified clinical psychologist, professor, and Canada Research Chair in Mental Health Innovation and Equity at the University of Ottawa. Her work focuses on mental health in communities of color, psychopathology research, discrimination, and interventions to reduce racism. Dr Williams has published more than 200 peer-reviewed articles, primarily on trauma, obsessive–compulsive disorder, and cultural concerns. She serves on the Scientific and Clinical Advisory Board of the International OCD Foundation and Accreditation Panel of the Canadian Psychological Association.

References

American Psychiatric Association . (2020, June 1). APA condemns racism in all forms, calls for end to racial inequalities in U.S. https://www.psychiatry.org/newsroom/news-releases/apa-condemns-racism-in-all-forms-calls-for-end-to-racial-inequalities-in-u-s

American Psychological Association . (2020, May 29). ‘We are living in a racism pandemic,’ says APA President. https://www.apa.org/news/press/releases/2020/05/racism-pandemic

Anthym

Tuitt

(2019). When the levees break: The cost of vicarious trauma, microaggressions and emotional labor for Black administrators and faculty engaging in race work at traditionally white institutions. International Journal of Qualitative Studies in Education, 32(9), 1072–1093. https://doi.org/10.1080/09518398.2019.1645907

Betancourt

J. R.

(2004). Cultural competence — marginal or mainstream movement? New England Journal of Medicine, 351(10), 953–955. https://doi.org/10.1056/nejmp048033

Bhui

Warfa

Edonya

McKenzie

Bhugra

(2007). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7, https://doi.org/10.1186/1472-6963-7-15

Borowsky

S. J.

Rubenstein

L. V.

Meredith

L. S.

Camp

Jackson-Triche

Wells

K. B.

(2000). Who is at risk of nondetection of mental health problems in primary care? Journal of General Internal Medicine, 15(6), 381–388. https://doi.org/10.1046/J.1525-1497.2000.12088.X

Boyer

C. J.

Rice

M. J.

Sorrell

T. R.

Spurling

A. M.

(2019). Advancing racial/ethnic and cultural sensitivity among PMHNP students through education, practice, and experience. Journal of the American Psychiatric Nurses Association, 25(6), 487–495. https://doi.org/10.1177/1078390318824651

Brown

Parham

Yonker

(1996). Influence of a cross-cultural training course on racial identity attitudes of white women and men: Preliminary perspectives. Journal of Counseling & Development, 74(5), 510–516. https://doi.org/10.1002/j.1556-6676.1996.tb01902.x

Bussey

Thompson

M. X.

Poliandro

(2022). Leading the charge in addressing racism and bias: Implications for social work training and practice. Social Work Education, 41(5), 907–925. https://doi.org/10.1080/02615479.2021.1903414

10.

Cénat

J. M.

(2020). How to provide anti-racist mental health care. The Lancet Psychiatry, 7(11), 929–931. https://doi.org/10.1016/S2215-0366(20)30309-6

11.

Cénat

J. M.

(2023). Complex racial trauma: Evidence, theory, assessment, and treatment. Perspectives on Psychological Science, 18(3), 675–687. https://doi.org/10.1177/17456916221120428

12.

Cénat

J. M.

Blais-Rochette

Morse

Vandette

M. P.

Noorishad

P. G.

Kogan

Ndengeyingoma

Labelle

P. R.

(2021a). Prevalence and risk factors associated with attention-deficit/hyperactivity disorder among US Black individuals: A systematic review and meta-analysis. JAMA Psychiatry, 78(1), 21–28. https://doi.org/10.1001/jamapsychiatry.2020.2788

13.

Cénat

J. M.

Broussard

Jacob

Kogan

Corace

Ukwu

Onesi

Furyk

S. E.

Bekarkhanechi

F. M.

Williams

Chomienne

M. H.

Grenier

Labelle

P. R.

(2024a). Antiracist training programs for mental health professionals: A scoping review. Clinical Psychology Review, 108, 102373. https://doi.org/10.1016/j.cpr.2023.102373

14.

Cénat

J. M.

Dalexis

R. D.

Darius

W. P.

Kogan

C. S.

Guerrier

(2022a). Prevalence of current PTSD symptoms among a sample of Black individuals aged 15 to 40 in Canada: The major role of everyday racial discrimination, racial microaggresions, and internalized racism. https://doi.org/10.1177/07067437221128462, 070674372211284.

15.

Cénat

J. M.

Dromer

Darius

W. P.

Dalexis

R. D.

Furyk

S. E.

Poisson

Bekarkhanechi

F. M.

Diao

D. G.

Gedeon

A. P.

Shah

M. S.

Labelle

P. R.

Bernheim

Kogan

C. S.

(2023). Incidence, racial disparities and factors related to psychosis among Black individuals in Canada: A scoping review. The Canadian Journal of Psychiatry, 68(10), 713–731. https://doi.org/10.1177/07067437231178957

16.

Cénat

J. M.

Farahi Moshirian

S. M. M. M.

Dalexis

R. D. R. D.

Corace

Moshirian Farahi

S. M. M.

Dalexis

R. D. R. D.

Corace

(2025a). Antiracist training and the development of cultural humility in mental health care providers in ethnically diverse schools in Canada. Canadian Psychology / Psychologie Canadienne. https://doi.org/10.1037/cap0000414

17.

Cénat

J. M.

Haeny

A. M.

Williams

M. T.

(2024b). Providing antiracist cognitive-behavioral therapy: Guidelines, tools, and tips. Psychiatry Research, 339, https://doi.org/10.1016/j.psychres.2024.116054

18.

Cénat

J. M.

Hajizadeh

Dalexis

R. D. R. D.

Ndengeyingoma

Guerrier

Kogan

(2022b). Prevalence and effects of daily and major experiences of racial discrimination and microaggressions among black individuals in Canada. Journal of Interpersonal Violence, 37(17–18), NP16750–NP16778. https://doi.org/10.1177/08862605211023493

19.

Cénat

J. M.

Kogan

Noorishad

P. G.

Hajizadeh

Dalexis

R. D.

Ndengeyingoma

Guerrier

(2021b). Prevalence and correlates of depression among black individuals in Canada: The major role of everyday racial discrimination. Depression and Anxiety, 38(9), 886–895. https://doi.org/10.1002/da.23158

20.

Cénat

J. M.

Kokou-Kpolou

C. K.

Blais-Rochette

Morse

Vandette

M. P.

Dalexis

R. D.

Darius

W. P.

Noorishad

P. G.

Labelle

P. R.

Kogan

C. S.

(2022c). Prevalence of ADHD among Black youth compared to white, Latino and Asian youth: A meta-analysis. Journal of Clinical Child and Adolescent Psychology. https://doi.org/10.1080/15374416.2022.2051524

21.

Cénat

J. M.

Lashley

Jarvis

G. E.

Williams

M. T.

Bernheim

Derivois

Rousseau

(2024c). The burden of psychosis in Black communities in Canada: More than a feeling, a Black family experience. Canadian Journal of Psychiatry, 69(1), 10–12. https://doi.org/10.1177/07067437231197263

22.

Cénat

J. M.

Manoni-Millar

David

Darius

W. P.

Kogan

C. S.

Dalexis

R. D.

(2025b). Barriers to mental health care for Black youth in Canada: A socioecological perspective. Canadian Psychology, 1–14. https://doi.org/10.1037/cap0000419

23.

Cénat

J. M.

Manoni-Millar

David

Darius

W. P.

Ndengeyingoma

Dalexis

R. D.

(2025c). Mental Health Perception in Black Communities in Canada: The Intergenerational Differences Between Youth and Parents. Journal of Cross-Cultural Psychology. https://doi.org/10.1177/00220221251348674

24.

Cénat

J. M.

Moshirian Farahi

S. M. M.

Gakima

Mukunzi

Darius

W. P.

Diao

D. G.

Bekarkhanechi

F. M.

Dalcé

Bangoura

B. K.

Mkhatri

Collom

Belachew

Josiah

Weisemberg

Labelle

P. R.

Dalexis

R. D.

(2025d). Prevalence and moderators of depression symptoms among Black individuals in western countries: A systematic review and meta-analysis among 1.3 million people in 421 studies. The Lancet Regional Health - Americas, 44, 1–12. https://doi.org/10.1016/j.lana.2025.101027

25.

Cénat

J. M.

Ndengeyingoma

Kogan

(2020a). How to provide anti-racist mental health care. https://doi.org/10.1016/S2215-0366(20)30309-6

26.

Cénat

J. M.

Ndengeyingoma

Kogan

Team

V. L.

(2020b). How to provide anti-racist mental health care . https://www.formationmentalhealthforeveryone.ca/en/

27.

Chae

D. H.

Yip

Martz

C. D.

Chung

Richeson

J. A.

Hajat

Curtis

D. S.

Rogers

L. O.

LaVeist

T. A.

(2021). Vicarious racism and vigilance during the COVID-19 pandemic: Mental health implications among Asian and black Americans. Public Health Reports, 136(4), 508–517. https://doi.org/10.1177/00333549211018675

28.

Constantine

M. G.

Melincoff

D. S.

Barakett

M. D.

Torino

G. C.

Warren

A. K.

(2004). Experiences and perceptions of multicultural counselling scholars: A qualitative examination. Counselling Psychology Quarterly, 17(4), 375–393. https://doi.org/10.1080/09515070412331331228

29.

Constantine

M. G.

Sue

D. W.

(2006). Addressing racism: Facilitating cultural competence in mental health and educational settings, xiii, 305. https://pitt.idm.oclc.org/login?url=http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=psyc5&AN=2006-10123-000. http://resolver.ebscohost.com/openurl?custid=s3733374&authtype=ip&sid=OVID:psycdb&pmid=&issn=&isbn=0471779970&volume=&issue=&s.

30.

D’Andrea

Daniels

Heck

(1993). The multicultural awareness, knowledge, and skills survey (MAKSS). In McGrath

Axelson

(Eds.), Accessing awareness and developing knowledge (pp. 9–15). Foundations for Skills in a Multicultural Society.

31.

Delphin-Rittmon

M. E.

Andres-Hyman

Flanagan

E. H.

Davidson

(2013). Seven essential strategies for promoting and sustaining systemic cultural competence. The Psychiatric Quarterly, 84(1), 53–64. https://doi.org/10.1007/S11126-012-9226-2

32.

Faber

S. C.

Khanna Roy

Michaels

T. I.

Williams

M. T.

(2023a). The weaponization of medicine: Early psychosis in the Black community and the need for racially informed mental healthcare. Frontiers in Psychiatry, 14, https://doi.org/10.3389/fpsyt.2023.1098292

33.

Faber

S. C.

Osman

Williams

M. T.

(2023b). Access to mental health care in Canada. https://doi.org/10.1080/00207411.2023.2218586

34.

Faber

S. C.

Williams

M. T.

Metzger

I. W.

Macintyre

M. M.

Strauss

Duniya

C. G.

Sawyer

Cénat

J. M.

Goghari

V. M.

(2023c). Lions at the gate: How weaponization of policy prevents people of colour from becoming professional psychologists in Canada. https://doi.org/10.1037/cap0000352

35.

Fante-Coleman

Jackson-Best

(2020). Barriers and facilitators to accessing mental healthcare in Canada for black youth: A scoping review. Adolescent Research Review, 5(2), 115–136. https://doi.org/10.1007/S40894-020-00133-2/FIGURES/1

36.

Fernando

(2010). Mental health, race and culture. Bloomsbury.

37.

Fix

R. L.

Testa

E. G.

Thurston

I. B.

Gray

W. N.

Russell

M. T.

(2022). Anti-racism strategies in pediatric psychology: Using STYLE can help children overcome adverse experiences with police. Journal of Clinical Psychology in Medical Settings, 29(2), 262–273. https://doi.org/10.1007/s10880-021-09804-1

38.

Giwa

Mullings

D. V.

Adjei

P. B.

Karki

K. K.

(2020). Racial erasure: The silence of social work on police racial profiling in Canada. Journal of Human Rights and Social Work, 1–12. https://doi.org/10.1007/s41134-020-00136-y

39.

Hargons

Malone

N. J.

Montique

C. S.

Dogan

Stuck

Meiller

Sullivan

Q. A.

Sanchez

Bohmer

Curvey

R. M. G.

Tyler

K. M.

Stevens-Watkins

(2022). Race-Based stress reactions and recovery: Pilot testing a racial trauma meditation. Journal of Black Psychology, 48(5), 645–677. https://doi.org/10.1177/00957984211034281

40.

Harrell

S. P.

(2000). A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. The American Journal of Orthopsychiatry, 70(1), 42–57. https://doi.org/10.1037/H0087722

41.

Hemmings

Evans

A. M.

(2018). Identifying and treating race-based trauma in counseling. Journal of Multicultural Counseling and Development, 46(1), 20–39. https://doi.org/10.1002/JMCD.12090

42.

Hernandez

Nesman

Mowery

Acevedo-Polakovich

Callejas

(2009). Cultural competence: A literature review and conceptual model for mental health services. Psychiatric Services, 60(8). https://doi.org/10.1176/appi.ps.60.8.1046

43.

Jarvis

Andermann

Ayonrinde

O. A.

Beder

Cénat

J. M.

Ben-Cheikh

Fung

Gajaria

Gomez-Carillo

Guzder

Hanafi

Kassam

Kronick

Lashley

Lewis-Fernandez

McMahon

Measham

Nadeau

Rousseau

Kirmayer

L. J.

(2023). Taking action on racism and structural violence in psychiatric training and clinical practice. The Canadian Journal of Psychiatry. https://doi.org/10.1177/07067437231166985

44.

Kanter

J. W.

Rosen

D. C.

Manbeck

K. E.

Branstetter

H. M. L.

Kuczynski

A. M.

Corey

M. D.

Maitland

D. W. M.

Williams

M. T.

(2020). Addressing microaggressions in racially charged patient–provider interactions: A pilot randomized trial. BMC Medical Education, 20(1), 88. https://doi.org/10.1186/s12909-020-02004-9

45.

King

Gurian

Stevens

(2010). Gender-Friendly schools. Educational Leadership, 68(3), 38–42. https://eric.ed.gov/?id=EJ971279

46.

Kirmayer

L. J.

Fernando

Guzder

Lashley

Rousseau

Schouler-Ocak

Lewis-Fernández

Fung

Jarvis

G. E.

(2021). A call to action on racism and social justice in mental health. Canadian Journal of Psychiatry, 66(6), 590–593. https://doi.org/10.1177/0706743720964333

47.

Knight

Jarvis

G. E.

Ryder

A. G.

Lashley

Rousseau

(2021). Ethnoracial differences in coercive referral and intervention among patients with first-episode psychosis. Psychiatric Services, 73(1), 2–8. https://doi.org/10.1176/appi.ps.202000715

48.

Knight

Jarvis

G. E.

Ryder

A. G.

Lashley

Rousseau

(2023). ‘It just feels like an invasion’: Black first-episode psychosis patients’ experiences with coercive intervention and its influence on help-seeking behaviours. Journal of Black Psychology, 49(2), 200–235. https://doi.org/10.1177/00957984221135377

49.

Kogan

C. S.

Noorishad

P.-G.

Ndengeyingoma

Guerrier

Cénat

J. M.

(2022). Prevalence and correlates of anxiety symptoms among black people in Canada: A significant role for everyday racial discrimination and racial microaggressions. Journal of Affective Disorders, 308, 545–553. https://doi.org/10.1016/J.JAD.2022.04.110

50.

Kunstman

J. W.

Ogungbadero

Deska

J. C.

Bernstein

M. J.

Smith

A. R.

Hugenberg

(2023). Race-based biases in psychological distress and treatment judgments. PLOS ONE, 18(10). https://doi.org/10.1371/JOURNAL.PONE.0293078

51.

Lenes

Swank

J. M.

Hart

K. A.

Machado

M. M.

Darilus

Ardelt

Smith-Adcock

Rockwood Lane

Puig

(2020). Color-conscious multicultural mindfulness training in the counseling field. Journal of Counseling & Development, 98, 147–158. https://doi.org/10.1002/jcad.12309

52.

Liu

(2020). White allyship. In Redeeming leadership: An anti-racist feminist intervention (pp. 141–156). Bristol University Press.

53.

Mattar

(2011). Educating and training the next generations of traumatologists: Development of cultural competencies. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 258–265. https://doi.org/10.1037/a0024477

54.

Miconi

Z. Y.

Frounfelker

R. L.

Santavicca

Cénat

J. M.

Venkatesh

Rousseau

(2021). Ethno-cultural disparities in mental health during the COVID-19 pandemic: a cross-sectional study on the impact of exposure to the virus and COVID-19-related discrimination and stigma on mental health across ethno-cultural groups in Quebec (Canada). BJPsych Open. https://doi.org/10.1192/bjo.2020.146

55.

Miville

M. L.

Carlozzi

A. F.

Gushue

G. V.

Schara

S. L.

Ueda

(2006). Mental health counselor qualities for a diverse clientele: Linking empathy, universal-diverse orientation, and emotional intelligence. Journal of Mental Health Counseling, 28(2), 151–165. https://doi.org/10.17744/MEHC.28.2.6KHC06T87C2FR7Y3

56.

Mollah

T. N.

Antoniades

Lafeer

F. I.

Brijnath

(2018). How do mental health practitioners operationalise cultural competency in everyday practice? A qualitative analysis. BMC Health Services Research, 18(1), 480. https://doi.org/10.1186/s12913-018-3296-2

57.

Osman

Williams

M. T.

Alftieh

(2024). State of the science on racial microaggressions. Behavior Therapy. https://doi.org/10.1016/J.BETH.2024.05.005

58.

Owen

Tao

K. W.

Imel

Z. E.

Wampold

B. E.

Rodolfa

(2014). Addressing racial and ethnic microaggressions in therapy. Professional Psychology: Research and Practice, 45(4), 283–290. https://doi.org/10.1037/A0037420

59.

Pieterse

A. L.

(2009). Teaching antiracism in counselor training: Reflections on a course. Journal of Multicultural Counseling and Development, 37, 141–152. https://doi.org/10.1002/j.2161-1912.2009.tb00098.x

60.

Porter

(1994). Empowering supervisees to empower others: A culturally responsive supervision model. Hispanic Journal of Behavioral Sciences, 16, 43–56. https://doi.org/10.1177/07399863940161004

61.

Public Health Agency of Canada . (2020). Social determinants and inequities in health for Black Canadians. A Snapshot. PLoS ONE 10, e0138511. https://doi.org/10.1371/journal.pone.0138511

62.

Richardson

Carriere

Boldo

(2017). Invitations to dignity and well-being: Cultural safety through indigenous pedagogy, witnessing and giving back!. AlterNative: An International Journal of Indigenous Peoples, 13(3), 190–195. https://doi.org/10.1177/1177180117714413

63.

Ridley

C. R.

Chih

D. W.

Olivera

R. J.

(2000). Training in cultural schemas: An antidote to unintentional racism in clinical practice. American Journal of Orthopsychiatry, 70(01), 65–72. https://doi.org/10.1037/h0087771

64.

Robb

(2014). National survey assessing perceived multicultural competence in art therapy graduate students. Art Therapy, 31(1), 21–27. https://doi.org/10.1080/07421656.2014.873691

65.

Rousseau

Gomez-Carrillo

Cénat

J. M.

(2022). Safe enough? Rethinking the concept of cultural safety in healthcare and training. British Journal of Psychiatry, 221(4), 587–588. https://doi.org/10.1192/bjp.2022.102

66.

Sarr

Knight

Strauss

Ouimet

A. J.

Cénat

J. M.

Williams

M. T.

Shaughnessy

(2022). Increasing the representation of Black, Indigenous, and People of Colour as students in psychology doctoral programmes. Canadian Psychology, 63(4), 479–499. https://doi.org/10.1037/cap0000339

67.

Seaton

E. K.

Carter

(2020). Pubertal timing as a moderator between general discrimination experiences and self-esteem among African American and Caribbean Black youth. Cultural Diversity and Ethnic Minority Psychology, 26(3), 390–398. https://doi.org/10.1037/cdp0000305

68.

Smith

Mak

(2022). The trajectory of awareness: A tool to dismantle anti-Black racism in social work education. Journal of Teaching in Social Work, 42(2–3), 120–141. https://doi.org/10.1080/08841233.2022.2048337

69.

Snowden

L. R.

(2001). Barriers to effective mental health services for African Americans. Mental Health Services Research, 3(4), 181–187. https://doi.org/10.1023/A:1013172913880

70.

Statistics Canada . (2022). The Canadian census: A rich portrait of the country’s religious and ethnocultural diversity. https://Www150.Statcan.Gc.Ca/N1/Daily-Quotidien/221026/Dq221026B-Eng.Htm, 1–25. https://www150.statcan.gc.ca/n1/en/daily-quotidien/221026/dq221026b-eng.pdf?st=JSh_ks4e

71.

Sue

D. W.

Sue

(2016). Counseling the culturally diverse: Theory and practice (7th ed.). Wiley.

72.

Sue

D. W.

Sue

Neville

H. A.

Smith

(2019). Counseling the culturally diverse: Theory and practice (8th ed.). Wiley.

73.

Sue

D. W.

Torino

G. C.

(2004). Racial-cultural competence: Awareness, knowledge, and skills. In Carter

R. T.

(Ed.), Handbook of racial-cultural psychology and counseling, Volume 2: Training and practice (pp. 3–17). http://site.ebrary.com.library.capella.edu/lib/capella/detail.action?docID=10114069 .

74.

Triplett

N. S.

Blanks Jones

J. L.

Ranna-Stewart

Kennedy

Daniels

Garfias

Jungbluth

Dorsey

(2023). Applying theater-based training methods to address anti-Black racism in community-based mental health services: A pilot feasibility study. Cognitive and Behavioral Practice. 31(2), 136–151. https://doi.org/10.1016/j.cbpra.2022.12.002

75.

Truong

Paradies

Priest

(2014). Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research, 14(1), 1–17. https://doi.org/10.1186/1472-6963-14-99/TABLES/1

76.

Tuckwell

(2003). White therapists and racial awareness. Counselling & Psychotherapy Journal, 14(2), 12–16.

77.

Vega

Tabbah

Monserrate

(2018). Multicultural school psychology training: An examination of students’ self-reported course outcomes. Psychology in the Schools, 55, 449–463. https://doi.org/10.1002/pits.22123

78.

Whaley

A. L.

Davis

K. E.

(2007). Cultural competence and evidence-based practice in mental health services: A complementary perspective. American Psychologist, 62(6), 563–574. https://doi.org/10.1037/0003-066X.62.6.563

79.

Williams

M. T.

Cénat

J. M.

Osman

Caldwell

Gallo

Faber

(2024). Les microagressions raciales comme obstacles au traitement en soins cliniques. https://doi.org/10.1037/cap0000383

80.

Williams

M. T.

Faber

S. C.

Duniya

(2022). Being an anti-racist clinician. The Cognitive Behaviour Therapist, 15(19), 1–22. https://doi.org/10.1017/S1754470X22000162

81.

Williams

T. R.

Walker

T. L.

Wyatt

W. N.

(2021). Conceptualizing racism through a systemic trauma lens: Impacts on black college students. Journal of Psychotherapy Integration, 32(1), 49–63. https://doi.org/10.1037/int0000206