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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 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 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 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, posttraumatic stress Legal and ethical issues Effective participation in multidisciplinary care team 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 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 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 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 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 Psychotherapy with individual youth re adjustment to illness, psychosocial stressors Participation in monthly peer group meetings as invited co-leader or presenter Supervision Modalities Audiotaped sessions In vivo sessions with mental health professionals Weekly case conceptualizations 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 Leadership in Neurodevelopmental Education (LEND) Graduate Professional Education (GPE) Posters and oral presentations of research Presentation on Program to Departmental Psychology Seminar Professional Presentations 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 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 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 Resources Latina Women Lijtmaer, R. (1998). Psychotherapy with Latina Women. Feminism & Psychology, 8(4), 537543. Youth Luna, G.C. (1997). Youths Living with HIV: Self-Evident Truths. Binghamton, NY: Hawthorn Press. http://www.advocatesforyouth.org/ Cultural Sensitivity Resources Transgender Individuals Lev, A.I. (2004). Transgender Emergence: Therapeutic Guidelines for Working with GenderVariant 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 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), 728747. O’Connor, M. (1997). Treating the Psychological Consequences of HIV. San Francisco, CA: Jossey-Bass. http://mentalhealthAIDS.samhsa.gov 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 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 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 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)