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The Adolescent Initiative at The Children’s Hospital of Philadelphia

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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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • Audiotaped sessions
  • In vivo sessions with mental health professionals
  • Weekly case conceptualizations
participation in clinic based research
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
presentations
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
hiv disease resources
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.
cultural sensitivity resources
Cultural Sensitivity Resources
  • 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
  • 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
  • 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

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
  • 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
  • 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
  • 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
  • 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
  • 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)
ad