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Training Psychologists in Clinical Work with Triply Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive. The Adolescent Initiative at The Children’s Hospital of Philadelphia Jerilynn Radcliffe, PhD, ABPP – Psychologist

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

The Adolescent Initiative at

The Children’s Hospital of Philadelphia

Jerilynn Radcliffe, PhD, ABPP – Psychologist

Linda A. Hawkins, MSEd – Mental Health Counselor


Training needs
Training Needs Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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


Plan for today s talk
Plan for Today’s Talk Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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 we’ve found helpful


Areas for training
Areas for Training Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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


Training methods
Training Methods Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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


Case review
Case Review Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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.


Journal club
Journal Club Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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


Outreach engagement
Outreach, Engagement Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • In vivo demonstrations of effective outreach techniques of youth

    • Case conceptualizations

    • Shadowing psychiatry

    • Role-playing

    • Community based learning

      • Movies, television shows, music, popular press


Mental health screenings
Mental Health Screenings Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • Standard of care: Yearly Beck Depression Inventory-II screens

  • Optional for cognitive status: Wechsler Abbreviated Scale of Intelligence

  • Yearly mental health “check-in”


Therapy counseling
Therapy/Counseling Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • Psychotherapy with individual youth re adjustment to illness, psychosocial stressors

  • Participation in monthly peer group meetings as invited co-leader or presenter


Supervision modalities
Supervision Modalities Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • Audiotaped sessions

  • In vivo sessions with mental health professionals

  • Weekly case conceptualizations


Participation in clinic based research
Participation in Clinic-Based Research Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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


Presentations
Presentations Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • Leadership in Neurodevelopmental Education (LEND)

    • Posters and oral presentations of research

  • Graduate Professional Education (GPE)

    • Presentation on Program to Departmental Psychology Seminar

  • Professional Presentations


Hiv disease resources
HIV Disease Resources Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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.


Cultural sensitivity resources
Cultural Sensitivity Resources Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • R. Savin-Williams (2001). Mom, Dad, I’m Gay: How Families Negotiate Coming Out. Washington, DC: APA.

  • D’Augelli, 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.


Cultural sensitivity resources1
Cultural Sensitivity Resources Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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


Cultural sensitivity resources2
Cultural Sensitivity Resources Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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/


Cultural sensitivity resources3
Cultural Sensitivity Resources Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

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.


Mental health resources
Mental Health Resources Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • HIV-related mental health issues for youth

    • Donenberg, G., & Pao, M. (2005). Youths and HIV/AIDS: Psychiatry’s role in a changing epidemic. Journal of the American Academy of Child & Adolescent Psychiatry, 44(8), 728-747.

    • O’Connor, M. (1997). Treating the Psychological Consequences of HIV. San Francisco, CA: Jossey-Bass.

    • http://mentalhealthAIDS.samhsa.gov


Legal ethical resources
Legal & Ethical Resources Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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.


What we ve learned
What We’ve Learned Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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


Plans for the future
Plans for the Future Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • Continue to develop library of resources for trainees

  • Involve trainees in advocacy on behalf of HIV-infected youth throughout the City of Philadelphia


Deepest appreciation
Deepest Appreciation Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive

  • 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)


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