Training Psychologists in Clinical Work with Triply Stigmatized Youth: Ethnic Minority, Sexual Orien

1
Training Psychologists in Clinical Work with
Triply Stigmatized Youth Ethnic Minority, Sexual
Orientation Minority, and HIV-Positive

• The Adolescent Initiative at
• The Childrens Hospital of Philadelphia
• Jerilynn Radcliffe, PhD, ABPP Psychologist
• Linda A. Hawkins, MSEd Mental Health Counselor

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Training Needs

• Youth with HIV are a rapidly increasing clinical
  population.
• CDC (2008). Largest increases in HIV diagnoses
  among youth of color below the age of 25,
  especially sexual minority males, a triply
  stigmatized group within contemporary U.S.
  society.
• Health needs of youth with HIV significant
• Adherence to medical care and medication
• Wide range of medical complications
• Lifestyle modifications required, but difficult
• Social impact within families and communities

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Plan for Todays Talk

• Describe the training areas available when
  working with youth living with HIV
• Present our approach to training future
  psychologists in effective work with these youth
• Share resources weve found helpful

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Areas for Training

• HIV as a disease and stigmatizing condition
• Cultural sensitivity for ethnicity, HIV stigma,
  sexual orientation diversity
• Disclosure and adherence issues
• HIV-related family disruptions
• Mental health problems depression,
  post-traumatic stress
• Legal and ethical issues
• Effective participation in multidisciplinary care
  team

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Training Methods

• Case Review
• Journal Club
• Mental health screenings
• Hands on training in outreach, engagement
• Group counseling participation
• In vivo and audiotaped sessions
• Participation in clinic-based mental health
  research
• Formal presentations

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Case Review

• Weekly multidisciplinary team meeting where all
  patients to be seen that week are presented,
  discussed, and planned for.
• Incorporates medical, nursing, social work,
  mental health, wellness counseling, and research
  planning
• Follow-up discussions of all patients seen the
  week prior are also held in Case Review.

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Journal Club

• Meets monthly, one hour
• Mental health team members, including all
  psychology trainees
• Leadership rotates among all participants
• Topics selected according to current clinical and
  research interests

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Outreach, Engagement

• In vivo demonstrations of effective outreach
  techniques of youth
• Case conceptualizations
• Shadowing psychiatry
• Role-playing
• Community based learning
• Movies, television shows, music, popular press

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Mental Health Screenings

• Standard of care Yearly Beck Depression
  Inventory-II screens
• Optional for cognitive status Wechsler
  Abbreviated Scale of Intelligence
• Yearly mental health check-in

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Therapy/Counseling

• Psychotherapy with individual youth re adjustment
  to illness, psychosocial stressors
• Participation in monthly peer group meetings as
  invited co-leader or presenter

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Supervision Modalities

• Audiotaped sessions
• In vivo sessions with mental health professionals
• Weekly case conceptualizations

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Participation in Clinic-Based Research

• Trainees participate in the design,
  implementation, and analysis of research
  findings.
• Recent studies
• Post-traumatic stress
• Spirituality and religiosity
• Transition to adult care
• Sexual health risk

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Presentations

• Leadership in Neurodevelopmental Education (LEND)
• Posters and oral presentations of research
• Graduate Professional Education (GPE)
• Presentation on Program to Departmental
  Psychology Seminar
• Professional Presentations

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HIV Disease Resources

• HIV as a disease
• Kalichman, S. (1998). Understanding AIDS, Second
  Edition. Washington, DC American Psychological
  Association.
• Bartlett, J. Finkbeiner, A. (2006). The Guide
  to Living with HIV. Baltimore, MD The Johns
  Hopkins University Press.

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Cultural Sensitivity Resources

• R. Savin-Williams (2001). Mom, Dad, Im Gay
  How Families Negotiate Coming Out. Washington,
  DC APA.
• DAugelli, A.R., Patterson, C.J. (2001).
  Lesbian, Gay, Bisexual Identities and Youth
  Psychological Perspectives. New York Oxford
  University Press.
• Ryan, C., Futterman, D. (1997). Lesbian and Gay
  Youth Care and Counseling. Adolescent Medicine
  State of the Art Review, 8(2). Philadelphia, PA
  Hanley Belfus, Inc.

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Cultural Sensitivity Resources

• African American
• Weston, K. (1991). Families We Chose Lesbians,
  Gays, Kinship. New York Columbia University
  Press.
• Boykin, K. (1996). One More River to Cross
  Black Gay in America. New York Doubleday
  Press.
• Myrick, R. (1999). In the Life Culture-specific
  HIV communication programs designed for African
  American men who have sex with men. The Journal
  of Sex Research, 36(2), 159-170

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Cultural Sensitivity Resources

• Latina Women
• Lijtmaer, R. (1998). Psychotherapy with Latina
  Women. Feminism Psychology, 8(4), 537-543.
• Youth
• Luna, G.C. (1997). Youths Living with HIV
  Self-Evident Truths. Binghamton, NY Hawthorn
  Press.
• http//www.advocatesforyouth.org/

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Cultural Sensitivity Resources

• Transgender Individuals
• Lev, A.I. (2004). Transgender Emergence
  Therapeutic Guidelines for Working with
  Gender-Variant People and Their Families. New
  York, NY The Haworth Clinical Practice Press
• Coleman, E., Bockting, W., Kirk, S. (2001).
  Transgender HIV Risks, prevention and care.
  Binghamton, NY Hawthorn Press.

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Mental Health Resources

• HIV-related mental health issues for youth
• Donenberg, G., Pao, M. (2005). Youths and
  HIV/AIDS Psychiatrys role in a changing
  epidemic. Journal of the American Academy of
  Child Adolescent Psychiatry, 44(8), 728-747.
• OConnor, M. (1997). Treating the Psychological
  Consequences of HIV. San Francisco, CA
  Jossey-Bass.
• http//mentalhealthAIDS.samhsa.gov

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Legal Ethical Resources

• Pope, K., Vasquez, M.J.T. (2007). Ethics in
  Psychotherapy Counseling A Practical Guide.
  San Francisco, CA Jossey-Bass.
• Anderson, J.R., Barret, B. (2001). Ethics in
  HIV-related Psychotherapy Clinical Decision
  Making in Complex Cases. Washington, DC
  American Psychological Association.

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What Weve Learned

• Importance of both formal and informal learning
  experiences
• Value of summarizing the experience through
  formal presentations
• Clinical work and research offer important and
  complementary learning opportunities

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Plans for the Future

• Continue to develop library of resources for
  trainees
• Involve trainees in advocacy on behalf of
  HIV-infected youth throughout the City of
  Philadelphia

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Deepest Appreciation

• Graduate Program in Psychology
• Project HOPE (American Psychological Association)
  for ongoing support around HIV-specific training
• APA-approved Internship Program at CHOP (Paul
  Robins, PhD Mary Rourke, PhD, Co-Directors)
• Postdoctoral Fellowship Program at CHOP (Melissa
  Alderfer, Director)