How Can Psychologists Help Men and Boys?

463536557Five people were wounded overnight in shootings on Chicago’s West and South sides, according to a report in this morning’s Chicago Tribune. It’s a headline that appears almost daily in my city, and the victims, all men age 16 to 32, are among the most disadvantaged in the city – and frankly, in the country. Perhaps more importantly, this violence, and the stress and trauma that it leads to, is taking a serious toll on the health of men and boys in poor, urban communities throughout our nation, according to presenters at a symposium today.

At the session, members of APA’s working group on health disparities in boys and men discussed reasons why this population and other underserved groups of men have some of the worst health outcomes in the country.

Working group chair Wizdom Hammond, PhD, of the University of North Carolina at Chapel Hill pointed to several psychosocial factors that contribute to these health disparities, including a need among men to endorse and demonstrate traditional traits of masculinity, including toughness, self-reliance, confidence and aggression.

“It’s likely that the strains and conflicts associated with trying to live up to this masculine ideal is at least partly responsible for producing the kinds of health disadvantages we’re seeing,” Hammond said.

The researchers explained that, compared to women, males are more likely to take health behavioral risks, delay preventive health screenings and care-seeking for health problems, minimize their physical and mental health symptoms and signs of distress and have higher rates of substance abuse. These behaviors are even more widespread among men of low socioeconomic status, those who are ethnic and racial minorities, those who are gay or bisexual, and those who have been incarcerated.

Particularly when it comes to mental health, men and boys are socialized very early not to talk about their emotions around traumatic experiences, said presenter Waldo Johnson, PhD, of the University of Chicago.

“Therefore, they tend to suffer in silence,” he said.

The group is now finalizing an evidence-based report and a series of best practices and recommendations on the topic, for dissemination to psychologists and other health providers. One thing is clear, Johnson said:

“Any prevention or treatment program for this population must account for the unique circumstances of men and boys.”

Integrated Approaches Improve Care, Lower Costs

100614692Fifty years ago, the president of the American Pediatric Society dreamed of employing psychologists in pediatric centers. Today, that dream of integrating physical and mental health care is a reality, thanks in part to 2008’s Mental Health Parity Act and the 2010 Affordable Care Act, said presenters at an APA convention symposium on innovative care strategies for youth.

Research shows integrated care not only reduces health-care costs, but benefits families and children, said Joan Asarnow, PhD, of the University of California, Los Angeles, Geffen School of Medicine, who conducted a meta-analysis looking at integrated care.

“When we go in and provide integrated care, our kids are more likely to get better,” she said.

But challenges remain. For one, mental health parity is not always well enforced and only 4 percent of Americans know that health insurers are required to provide comparable coverage for mental and physical health care, according to an APA survey.

Further, disparities persist in mental health care: Minorities with mental health disorders are much less likely to receive mental health care — and appropriate care — than white populations, said Jeanne Miranda, PhD, of the University of California, Los Angeles. Minorities are also vastly underrepresented in the mental health care workforce.

To overcome such barriers and better integrated mental and physical health care, speaker Marc C. Atkins, PhD, of the University of Illinois at Chicago, called for expanding the mental health workforce, realigning mental health resources and developing a natural extension from prevention to intervention.

Tailoring interventions on a smaller scale is important, too, said W. Douglas Tynan, PhD, director of integrated care at APA who offered suggestions for those looking to integrate mental health care into existing primary-care clinics. “After you find out [the clinic’s] greatest need, develop a protocol and then develop a practice team,” he said.

Sharon G. Portwood, JD, PhD, of the University of North Carolina at Charlotte, said keeping prevention and wellness “at the forefront” of efforts is also key.

Psychologists have a key role to play in all of this work since many are experts in interventions that improve health outcomes, such as motivational interviewing, self-management training and problem-solving, said Terry Stancin, PhD, of MetroHealth Medical Center. “There’s a very important role we have to play in integrated-care settings,” she said.

Integrative Primary Care & Psychologists

integrative healthI attended a session Friday morning titled “Improving Outcomes for the Underserved: The Role of Integrated Primary Care.” The panel provided an overview of models of service delivery and highlighted key components to make integrative systems work effectively. I assume that this is an important topic for many psychologist and mental health professionals as the room was packed with standing room only (or floor seats for those who chose).

Why is this important to psychologists?

Health care reform and integrative primary care have been hot topics for several years. The Obama administration and Congress have played a major role in integrating mental health into primary care. The APA has also been involved in these discussions and highlighting the role of psychologists who work in primary care settings. You can visit the APA website for more information on health care reform and APA’s priorities (http://www.apa.org/health-reform/index.html).

Psychologists are experts in behavioral change. Therefore, it is imperative that they have a seat at the table when policymakers are discussing ways to improve mental and physical health. Psychologists have been working in integrated primary care settings for decades, providing behavioral health services. According to the APA, psychologists play a vital role in health promotion and disease prevention.

Roles of psychologists in integrative care include:

  • Psychologists possess the essential therapeutic skills for delivering treatment to substance abuse clients, including empathy, good listening skills and training in evidence-based methods known to curb addictive behaviors.
  • By assessing a client’s needs, abilities or behavior using a variety of methods, including psychometric tests, interviews and direct observation of behavior, psychologists help tobacco users quit smoking.
  • Psychologists have the ability to address factors associated with risky sexual behaviors and devise strategies for patients to meet their individual needs.
  • Psychologists possess the ability to devise and monitor appropriate programs of treatment, including therapy, counseling or advice, in collaboration with colleagues to assist adults and children in coping with the psychological factors associated with injury and violence.
  • Psychologists possess the skills necessary to assist patients in making behavioral changes to adopt physical activity to increase their mental well-being.
  • Psychologists can address both parent and infant anxiety before and during the immunization process and can develop materials and information on the behavioral aspect of immunization.

How is this important to meeting the needs of the underserved?

According to Dr. Dennis Freeman, under-served populations are the highest users of primary care services. “To improve cost and outcomes, we need to understand the impact of psychosocial factors,” he said. Given the shift in intgrative2health care reform to from traditional care to  community mental health centers, psychologists need to know how to be involved in these changes.

Whereas underserved populations over-use primary care and emergency room services, we know from the literature that they often under-utilize mental health services. Integrating mental and physical health care bridges a gap for psychologists to work with underserved groups. Dr. Freeman also noted “patients with mental disorders often have co-morbid medical conditions,” which may another reason why underserved seek medical care before seeking behavioral health services.

Stronger Together: How to Build Resilience to Community Violence

riskandresilience

What strengths-based solutions can psychologists develop in response to community violence? A panel of psychologists who work with widely disparate groups tackled this question for the Public Interest collaborative program — “Risk and Resilience – Overcoming Exposure to Community Violence.” What common thread united each of the panelists’ work? The importance of resilience in addressing each group’s needs.

Dr. Karen Roberto found that intimate partner violence (IPV) directed at older women was a little understood issue in the New River Valley community of rural Virginia. Many community members held inaccurate and ageist notions about older women being targets of IPV – “old people don’t do that.” Dr. Roberto joined forces with the local Women’s Resource Center and developed a three-tiered action plan with short-, medium- and long-term goals for providing direct services and educational materials to older IPV victims and training on late life IPV for volunteers at the center. This local collaborative effort strengthened the response to IPV at both individual and systemic levels.

Violence in rural communities is understudied, perhaps due to the nostalgic view of rural areas as crime free and pastoral, according to Dr. Velma McBride Murry. Her research focused on how community violence affects rural African-American parents’ psychological functioning and their parenting processes. Drawing on data from the Family and Community Health Study (involving 897 families), she found supportive community connections create a protective function for these families by enhancing parents’ abilities to parent well.

Dr. Alexandra Pierce, a member of APA’s Task Force on Trafficking of Women and Girls, echoed the consistent theme of gaps in the research. “Nothing has been published on sexual trafficking of American Indian girls.,” Her Oshkiniigikwe program had to start from scratch. This community-based program in Minnesota works with homeless American Indian females ages 12-21, many with histories of abuse, trauma or exposure to commercial sexual exploitation. The program draws on American Indian cultural teachings such as “survive and resist” and offers intensive case management along with programs on healthy sexuality and relationships and mind-body medicine. In encouraging news, at six month follow-up, 90 percent of the girls stayed in or graduated from high school, and 80 percent reported avoiding sexual exploitation.

Dr. Muninder Ahluwahlia focused on the resilience that the Sikh community has had to develop post-9/11. Sikhs have become targets of record high discrimination, racial profiling and hate crimes from Americans directing their vitriol at anyone they perceive as Muslim — wrongly in this case. In response, the Sikh community draws resilience from religious and cultural resources such as gurdwaras (i.e., places of worship and community gatherings), youth camps, and online communities that strengthen geographically scattered groups.

Dr. Ann Masten, as discussant, closed the session by applauding how each case presented reflected resilience at work, or, as she phrased it the ability of dynamic systems to adapt successfully to disturbances that threaten their function, viability and development.”

How Can Psychologists Help Reduce Health Disparities in America?

80377215It doesn’t seem to make sense: Black American women with college degrees have higher infant mortality rates than the most disadvantaged and uneducated women of every other race and ethnicity, with the exception of American Indians. This is just one of several sobering facts revealed at a Thursday APA convention symposium titled “Disentagling Race/Ethnicity and SES – Implications for Understanding and Reducing Health Disparities.”

Presenter David Williams, PhD, of Harvard University explained that these striking racial disparities often occur because health is affected not only by their current socio-economic status (SES), but also by exposure to adversity over their entire lives.

“Those African American college-educated women are more likely to be the first generation to attend college, they’re more likely to be born poor and of low birth weight, with less access to nutrition and medical care,” Williams said.

Psychologists have a key role to play in developing interventions to mitigate the negative effects of race and SES on health, said APA President Norman B. Anderson, PhD. In particular, he pointed to the success of some family-based training programs in improving biological, behavioral and cognitive outcomes among children from minority and low SES households. He also shared information on APA’s ongoing work to address health disparities, including the 2012 Summit on Obesity in African American Women and Girls and the association’s newly formed working group on stress and health disparities.