The CATINA Method

Culture check

Ask questions

Test your EQ

Investigate

Nine-point check

Ally: Be an ally

Culture Check

Check with your client for the importance of race and gender. This type of question can be revisited after several sessions. Do not under estimate how your black client has been conditioned to minimize themselves in the presence of white people. 

It is important to understand how society views the black community. As a mental health professional, you must use the person-in-environment (PIE) theory to adequately address and understand their culture. Have consideration for how the news and media portrays black people and enforces stereotypes.

Use Person Centered Therapy as the method of engagement. A Black person on the spectrum is most likely to be different from their cultural upbringing. This person will have a deeper sense of not belonging. The need to be seen, heard, and validated is pivotal.

For clients over the age of 18, open ended questions may provoke the subconscious need to mask and give a rehearsed response. It is likely to create anxiety. Probing questions are more structured and allows the individuals process of thought and opinion to be authentic.

Be mindful of the impact that Black people are not equally protected by local law enforcement. This has been an ongoing issue for numerous years. When Black people and white people hear police sirens, there are two distinctly different psychological experiences. One of safety and security. The other fear and worry. According to columbiapsychiatry.org “The Black community suffers from an increased rate of mental health concerns, including anxiety and depression. The increased incidence of psychological difficulties in the Black community is related to the lack of access to appropriate and culturally responsive mental health care, prejudice and racism inherent in the daily environment of Black individuals, and historical trauma enacted on the Black community by the medical field. Moreover, given that the Black community exists at the intersection of racism, classism, and health inequity, their mental health needs are often exacerbated and mostly unfulfilled. Issues related to economic insecurity, and the associated experiences, such as violence and criminal injustice, further serve to compound the mental health disparities in the Black population.” This is your opportunity to ensure a safe space for healing with full acknowledgment of systemic racism presence in society. 

Ask

No one has all the answers. Not even the CDC. According to cdc.gov “Black and Hispanic children continued to be less likely to be identified with ASD than white children. These differences suggest that black and Hispanic children may face socioeconomic or other barriers that lead to a lack of or delayed access to evaluation, diagnosis, and services.” The discrepancies I have with this report is that the CDC makes the assumption and suggest that autistic black and Hispanic children are disadvantaged by socioeconomic barriers that lead to a lack of or delayed access to evaluation, diagnosis, and services.”  The truth is that the medical and educational professionals do not assess and evaluate black and Hispanic children equally. As a black woman I have spent most of my life stereotyped as single, single parent, poor, uneducated, and unmarried. This narrative has improved.  In recent years it is noted that Black women receive degrees at a higher rate, are among the most educated, vote at higher rates than the rest of the population and starting more businesses than any other groups of women. Despite the hard work and tenacity of black women, the CDC’s August 27, 2019 report continues to push the narrative undiagnosed minority children face socioeconomic or other barriers instead of the blatant fact that they are overlooked and not included.

Keep in mind that it is not the responsibility of black people to educate white people on how to correct problems created by white people.  When seeking knowledge based on culture, you must be willing to ask yourself difficult questions. According to psychology today, white therapists should ask themselves:

“Do you feel competent to ask about, respond to, and support clients regarding their experiences of racism, oppression, and intersectionality?

Are you willing to address racial differences with clients early in therapy?

Can you talk about white privilege and what it means to be white?

If you identify as white, identify several areas of privilege you did not realize were a privilege of being white until you learned about white privilege.”  

Do you spend time with around the population you serve outside of work hours?

Reading books, watching documentaries and cultural diversity training is the bare minimum. Therapists should have experience working under a supervisor who can skillfully help navigate issues surrounding culture, race, and stigma with their clients. Autism Spectrum Disorder does not discriminate, and neither should the mental health industry and the professionals who deliver care.

Test Your EQ

Emotional intelligence (emotional quotient or EQ) is the ability to understand, use, and manage your own emotions in positive ways to relieve stress, communicate effectively, empathize with others, and overcome challenges. Have an honest understanding of your strengths and limitations before seeing a client of color. White fragility and microaggressions are detrimental to the therapeutic process. According to Zencare.com, the work of awakening to our privileges and biases, understanding systems of oppression, and creating a safe and understanding space for clients is hard, daily, and ongoing work. It can bring up guilt, shame, and defensiveness. Practice self-compassion and patience, lean into the tension, and as Dr. Chandy put it, “move through it towards connection and engagement” with clients.  When dealing with emotionally sensitive issues such as race, it is important to be your best self. Addressing the issues of Black people and Autism will require a level of self-care and genuine empathy that may not come easily. If your emotional intelligence is in check, you will be prepared to face the tough issues with all parties feeling seen, heard and validated.

Ask yourself a few simple questions:

Do I have frequent disagreements?

Do I know the difference between assertive and aggressive?

Do I feel that others are too sensitive?

Am I too sensitive?

Do I have difficulty understanding others points of view?

Do I avoid difficult conversations?

Am I a people pleaser?

According to psychologytoday.com, “an emotionally intelligent individual is both highly conscious of his or her own emotional states, even negativity—frustration, sadness, or something more subtle—and able to identify and manage them. Such people are especially tuned in to the emotions that others experience. It’s understandable that a sensitivity to emotional signals both from within oneself and from one’s social environment could make one a better friend, parent, leader, or romantic partner. Fortunately, these skills can be honed.”

Investigate

Investigate the latest journals, peer reviewed articles and government websites about Black people on the autism spectrum. Question the equality in research. Understand that until there are research studies and organizations that focus on people of color on the autism spectrum, there will always be a lack of representation, medical assistance and services.

An effort to identify minorities on the spectrum will require, addressing the relationships with families. Trust, education and follow through is key.  Counseling 101: Establishing trust and rapport is an essential part of a healthy therapist-client relationship. If the client and the community feels embraced, safe and respected, there can be relationships formed. Next, you must educate the family/ community about autism. Talk to Black people who are adults on the spectrum and let them educate you on their experiences growing up. This can give valuable insight to identifying black children. As an ice breaker use the nine-point checklist to get the conversation started, before using medical terminology in a manner that can be off putting. This has nothing to do with socioeconomic status or intelligence. The basis of Autism symptoms are that of white males and the culture which surrounds him. For instance, eye contact has different meanings for different cultures. Indirect eye contact is a sign of respect and humility in some cultures. That same behavior may be judged as lying, deceitful, untrustworthy or dangerous to a white person in a position of authority or a white person who feels s/he is the authority just because they are white. Simply put: culture matters and you must do your due diligence to get the best result.  Follow through is the game changer. After establishing rapport and making the connection you must commit to the relationship. Following through with being the change that is needed to help to connect with services like our white fellow Autistics, would mean so much.  Autistic people of color need allies. Allies who are determined to see change and be a part of it.

Nine Point Check

It’s important that you understand the culture and language of the parents so you can address the child/ individual appropriately. Below, is a list of common descriptions made by black caregivers describing their child’s behavior. Your active listening skills can make all the difference for a black person to get early treatment and services.

1. Caregivers complain about the individuals refusal to speak. Delayed speech. Pointing to desired objects, non-verbal. Episodes of unexplained frustration due to communication difficulties.
2. Individuals are judged to be rude and dismissive.  Described as “unfriendly” or “mean” because s/he doesn’t smile and usually has a flat, serious expression. Does not change demeanor for authority figures.
3. Parent describes the child as quiet and well behaved. The individual is overly compliant: goes along to get along with minimal pushback. 
4. Individuals are “different” from their siblings. Very sensitive to their environment, whereas siblings and other peers are able to adjust. i.e. lights, sounds, city living. 
5. Lack eye contact and/or engage in empty stares. Lack responsiveness to command for interpersonal engagement. i.e. “Come here, look at me when I’m talking to you and do as I say.”  
6. Child/ individual enjoys solitary activities and interests.  Does not want others touching their things. 
7. Described as simple and naive. Person appears to allow others to use and take advantage of him/her. 
8. Avoids arguments and altercation. The individual is not ‘tough’.  Likely bullied by family member(s) and peers. 
9. Does not strictly identify with black culture. Sees self as an individual first and black person second. Has their own sense of style. Dress for comfort. Not to impress.

Alliance

Integrate Black therapists in practices where most professional staff are white. Consult with Black clinicians. Pay them their worth. Be transparent and open to permanent change. Take a stance. Use your privilege and your power to bring attention to the lack of research and intervention for people of color on the spectrum. In the United States and other countries around the world, people of color rank low in Maslow’s Hierarchy of needs. Systemic racism suppresses people of color and the need for control and order in their lives. People of color lack basic security and safety needs such as the policing in our communities. Being an ally can help to bring change in areas that people of color cannot reach.

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1. Katschnig H. (2006). Quality of life in mental disorders: challenges for research and clinical practice. World psychiatry : official journal of the World Psychiatric Association (WPA), 5(3), 139–145. 
2. Emotional Intelligence   https://www.psychologytoday.com/us/basics/emotional-intelligence
3. Addressing Mental Health in the Black Community NewsFebruary 8, 2019. By Thomas A. Vance, Ph.d  https://www.columbiapsychiatry.org/news/addressing-mental-health-black-community# 
4. Mental Health in the Black Community |www.columbiapsychiatry.org
5. https://blog.zencare.co/how-white-therapists-address-racism-black-clients/
6. https://www.psychologytoday.com/us/blog/culturally-speaking/201905/is-your-therapist-qualified-treat-people-color
7. https://www.cdc.gov/ncbddd/autism/addm-community-report/differences-in-children.html