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The Adolescent Initiative at The Children’s Hospital of Philadelphia

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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The Adolescent Initiative at The Children’s Hospital of Philadelphia

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  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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.

  7. 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

  8. 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

  9. 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”

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

  11. Supervision Modalities • Audiotaped sessions • In vivo sessions with mental health professionals • Weekly case conceptualizations

  12. 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

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 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/

  18. 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.

  19. 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

  20. 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.

  21. 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

  22. 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

  23. 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)

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