Session
Health Equity and Anti-Oppressive Public Health Social Work Practice
APHA 2022 Annual Meeting and Expo
Abstract
Understanding Black Gay Men’s Experience with Racism in Therapy to Advance Health Equity: A qualitative interview study
APHA 2022 Annual Meeting and Expo
Racism and discrimination negatively impact the mental health of LGBTQ and BIPOC communities. Intersectional research on this topic is sparse. The goal of this study is to understand the experiences of Black gay men seeking mental health treatment and the impact of racism when engaging with a predominantly White mental health workforce.
This qualitative study utilized an Interpretative Phenomenological Analysis (IPA) and purposive sampling to recruit a homogenous sample of (N=4) Black gay men (ages 25-35) from the Greater Boston area. The accepted study size for IPA studies is 3-6 participants.
Principle themes: 1) Impact of racism in the mental health system: long wait times, settling for White therapists, putting in extra work to find a therapist of color; 2) Harms in therapy: therapist ignores their racists acts, and the complexity of holding how the therapist has helped and harmed them; and 3) Urgency need to address racism in this system.
The harm experienced by these participants are not unique, just not well published. Their stories highlight the undue burden needed to avoid and deal with racism in the mental health system. Public health social workers are uniquely positioned as providers of care and leaders of institutional and state policies. As social workers address racism and anti-Blackness, it is important to: 1) Value the expertise from the community through methods like IPA and not over research minoritized communities; 2) Challenge existing policies that exacerbate mental health disparities; 3) Develop and implement intentional training and policies interventions based on community feedback.
Abstract
Spatial accessibility to primary healthcare services for low-income adults in New Jersey: How about their aspatial accessibility?
APHA 2022 Annual Meeting and Expo
Purpose: The U.S. healthcare system has been searching for ways to increase health care coverage and reduce costs. One of the constant efforts is to increase the access to and utilization of primary care and preventative services. In line with national trends, New Jersey has experienced growth in the volume of primary care and preventive services, contributing a rapid increase in accessibility to health care. Recent studies that investigated variations in accessibility suggest the need to examine issues surrounding affordability and availability of services. Considering accessibility is a multidimensional concept since distinction can be made between potential or revealed accessibility as well as spatial and aspatial perspectives, this study is aimed at identifying and measuring the distribution of primary and preventive services in New Jersey, with the hypothesis being that low-income adults still have aspatial accessibility.
Method: Data came from New Jersey Department of Health in combination with American Community Survey data. Spatial accessibility of primary care and preventive services was measured as physical accessibility based on a distance and availability based on provider to low-income non-elderly adult ratio at the census tract level. Aspatial accessibility was measured as affordability of health services. Then, regression analyses were performed to explore characteristics of low-income adults who have different combinations of low accessibilities (geographic accessibility, availability, and affordability).
Results: Using geographic information systems, we mapped primary/preventive care centers, geographic accessibility and availability, and affordability. About two thirds of low-income adults had geographic accessibility to primary care and preventive services. However, the availability appeared to vary across the areas and low-income adults living in poor neighborhood experienced low availability. The majority of low-income adults experienced health care cost burdens, showing low affordability of the necessary healthcare services. It was noted that low-income adults in rural areas tended to experience difficulties with both spatial and aspatial accessibility.
Conclusion: Our findings inform the importance of examining a multidimensional concept of accessibility of primary care and preventive services. Findings contribute to the policy conversation regarding the need to focus on the areas with lower levels of availability and affordability with special attention to low-income adults in rural areas. Future studies should suggest new healthcare delivery models that predict and evaluate current and future primary and preventive care needs to increase access to care.
Abstract
An intergenerational service-learning project to address social isolation, ageism, and build the public health and social work workforce
APHA 2022 Annual Meeting and Expo
Background. According to the United States Administration on Aging, there are over 54 million older adults (age 65+) in the US, and they are expected to make up 22% of the population by 2040. Social isolation, which is a risk factor for a range of poor health outcomes, is prevalent among older adults and has been exacerbated by the Covid-19 pandemic. Ageism also adversely impacts this population in myriad ways. Educators have begun to combat ageism through the Positive Education about Aging and Contact Experiences (PEACE) model, which includes didactic education addressing negative and inaccurate beliefs, as well as experiential learning to facilitate positive interactions with older adults.
Description. In 2021, faculty from the MSW and MPH programs at West Chester University began working with the Pennsylvania Department of Aging (PDA) to address the interrelated problems of a growing aging population and shrinking workforce, social isolation, and ageism. The resulting program used the PEACE model, including a service-learning project, with 43 students in three graduate courses across social work and public health. Students participated in an “Ageism First Aid training from the Gerontological Society of America, an interactive learning session with leadership from the PDA, and two learning modules covering assessment and communication with older adults. Students were then connected to a community-based older adult at-risk of, or experiencing, social isolation. Pairs met virtually on a weekly basis for eight weeks. Area Agencies on Aging (AAA) facilitated student-older adult connections and helped trouble-shoot communication challenges.
Lessons Learned. Preliminary evaluation findings revealed positive experiences and changes in attitudes about older adults. Stories from students included opportunities to extend and apply course content through conversations with their older partners. However, we found the need to reframe the purpose of the project from one that benefitted older adults (i.e., addressing social isolation), to one that offered mutual and reciprocal benefits to students through the learning afforded them by their older partner. We attribute this lack of awareness among some students to the intensity with which ageism is embedded in our culture and plan to expand the ageism training in future semesters.
Implications. Positive feedback from students, older adults, the PDA and the AAA suggests this interdisciplinary, intergenerational service-learning project offers many benefits to students, older adults and the broader community. Instructors and professionals in public health and social work should consider developing similar programs to help address ageism, social isolation and workforce development.
Abstract
Health equity: tools to build skills in the public health workforce
APHA 2022 Annual Meeting and Expo
The COVID-19 pandemic placed a spotlight on the vast inequities entrenched in our communities and health care systems. The stark and prolific nature of these structural factors require public health leaders who are equipped with a robust understanding of the root causes and an ability to design interventions centered in equitable practices and principles.
This session will introduce participants to a successful model for building skills in health equity among the public health workforce. The PHI Center for Health Leadership and Impact (CHLI) has trained more than 2,000 public health leaders across 53 states and territories through its Leadership Academics and Overdose Prevention Networks. Both programs help participants understand health equity and how to implement work that disrupts the systems that produce those inequities. Equity principles are embedded across all workshops, tools, and coaching sessions to integrate concepts into their leadership development and applied practice. External evaluations demonstrate that 95% of participants would recommend these programs to colleagues and continue to apply the skills towards their current work.
Presenters will describe the core features of CHLI’s equity programming that can be adapted for individuals, teams, and organizations across the county. They will also demonstrate specific tools that prepare teams to promote health equity and illustrate case studies from California, Texas, Iowa, and Mississippi.
Abstract
“My doctor always asks me to quit drinking, but I don’t drink at all”: Experiences of Healthcare Use among Urban-Dwelling Indigenous Taiwanese
APHA 2022 Annual Meeting and Expo
Backgrounds: Taiwan is considered an origin of the Austronesian diaspora, with the indigenous Taiwanese of high degrees with genetic and linguistic diversity. Due to the colonial legacies, indigenous Taiwanese not only lost their languages and cultural practices, but suffer from significant health disparities, despite the national health insurance is available for all citizens. Therefore, this study aims to explore the experiences of healthcare utilization among urban-dwelling indigenous Taiwanese (UDIT), as patients' experiences are associated with many health behaviors and treatment outcomes.
Methods: This study used the phenomenological approach to interview 40 adult UDITs, as well as analyze their stories about recent visits to healthcare organizations. We highlighted how clinical interactions between UDITs and healthcare providers (HCPs) may shape UDITs' experiences, resulting in positive or negative health sequelae.
Results: The majority of our participants did not encounter significant discriminatory events, attributing this experience to the facts that HCPs are unaware of their UDIT identity, their appearances are indistinguishable from other non-indigenous patients, HCPs worry their discriminatory behaviors may be filmed and exposed on the internet, and HCPs focus on physical symptoms rather than patients. However, many UDITs shared their experiences of microaggression during clinical encounters: After their UDIT identity is disclosed, HCPs may cite UDIT’s stereotypes, especially alcohol use and poverty, to guide clinical decisions and recommendations without confirmations from UDIT patients, resulting in missed opportunities for accurate interventions and constrained treatment options.
Conclusions: Culturally-sensitive care is urgently needed to help reduce health disparities faced by the UDIT community.
Abstract
Equity and access to outdoor therapies for diverse adolescent populations: Scoping review and lessons for research and practice
APHA 2022 Annual Meeting and Expo
This scoping review aims to identify relevant literature and evaluate how sociodemographic factors—such as race/ethnicity, sex/gender, and socioeconomic status—influence access to and participation in outdoor therapy programs. Outdoor therapy is a growing field of evidence-based mental and behavioral health treatment in which nature is perceived as a major component of the therapeutic process.
The primary population of focus for this study is adolescents struggling with persistent, moderate to severe mental health issues. Currently, there is limited research regarding diversity, equity, inclusion (DEI), and social justice within outdoor therapy programs. This review aims to identify gaps in the literature surrounding these issues. We also discuss ways to advance DEI in outdoor therapy programs from a transdisciplinary perspective that integrates social work, public health, psychology, and environmental justice lenses.
Literature from 2010 to 2021 was evaluated using a systematic search string applied to the PubMed, PsycInfo, and Sportdiscus databases. Inclusion criteria were: English-language literature from 2010- 2021, social justice/DEI, mental health, adolescents ages 12-18 in outdoor therapy programs. Seventy-four abstracts were identified from the initial search; after further screening, approximately 15% met criteria for full-text review. Articles were coded and synthesized using thematic analysis.
Studies reported small to large effect sizes, documenting improved functioning across many areas including individual social-emotional learning, the family unit, and school settings. Most studies reported minimal sociodemographic information regarding their population. When demographic data was reported, white males were most frequently represented.
Among outdoor therapy programs, the approaches to and objectives of treatment align with the goals of community-based preventive health models. Moreover, treatment objectives and approaches demonstrate potential to improve quality of life. However, findings from the scoping review suggest that greater attention must be placed on enhancing diversity, equity, inclusion, and social justice within these programs, as well as addressing myriad barriers to access. Future research should collect and analyze sociodemographic information and utilize mixed methods to explore how race/ethnicity, sex/gender, and/or socioeconomic status—as intersectional identities—can be accounted for to promote social justice in outdoor therapeutic settings. Transdisciplinary collaborations nationally and globally are currently accelerating these efforts.
Abstract
Using Critical Race Theory to Un-model the Model Minority Myth
APHA 2022 Annual Meeting and Expo
Asian, Pacific Islander and Desi Americans (APIDA) have been marginalized throughout U.S. history. In the late 1800s, Asian immigrants were described as “yellow peril, a term popularized to instill fear of job loss at the hands of Asian immigrants. As APIDA gained citizenship, “perpetual foreigner was coined to emphasize that even as U.S. citizens, APIDA are not fully American (Armenta et al., 2013). With the educational and financial success of some APIDA, the term “model minority from the 1960s reinforced the stereotype of APIDA as the exemplar racial minority group (Yoo et al., 2010). Now during COVID-19, the term “kung-flu virus is used to blame APDIA for the pandemic.
The model minority myth, in particular, is harmful because it: 1) ignores the heterogeneity of APIDA groups and obscures academic struggles within APIDA subgroups; 2) distorts and minimizes actual experiences of racism faced by APIDA; 3) positions APIDA hierarchically between whites and other racial minority groups; and 4) assumes that APIDA do not need resources and support.
This study draws on Critical Race Theory (CRT) to elucidate how racism has become normalized and is perpetuated through social structures and institutions. CRT in particular highlights how the model minority myth is a form of anti-blackness.
This study uses a sequential, explanatory mixed-methodological design to: 1) test a conceptual model in which the internalization of the model minority myth predicts adverse outcomes (i.e., psychological distress, sense of belonging, and academic success) in APIDA college students (N=304); and 2) conduct focus groups with select survey respondents (N=30) to gain a deeper understanding of the findings from the survey study including the role of critical consciousness.
Preliminary results suggest that APIDA college students are experiencing high levels of psychological distress and manifesting the internalization of racism differently. Additionally, certain APIDA subgroups (e.g., South Asians, males) exhibit significantly different levels of internalized racism and critical consciousness than their peers.
By 2055, APIDA immigrants will surpass Latinx to become the largest immigrant group in the U.S., yet APIDA continue to be invisible in research (Museus, 2009). This study aims to deepen understanding of how internalized racism impacts psychosocial outcomes on an individual level so that we can address how institutions (e.g., higher education) can support APIDA college students in resisting anti-APIDA discrimination.
Abstract
Predictors of African American Men's Perceived Health
APHA 2022 Annual Meeting and Expo
African American (AA) men continue to have poor health outcomes and the lowest life expectancy among their peers. While there has been a growing interest in improving AA men’s health, much of the research has focused on social determinants of health; however, there has been scant research on the effects of holistic wellness on health outcomes. Perceived wellness, defined holistically, encompasses physical, emotional, intellectual, social, and spiritual aspects of human functioning with the goal of achieving balance across domains. A holistic approach to wellness has been linked to increased psychological functioning as well as prevention and treatment of physical conditions. This study aimed to explore the relationship between wellness dimensions and health among AA men. An exploratory cross-sectional study was conducted to examine perceptions of wellness among a sample of 107 AA men. The Wellness Self-Perception Questionnaire (WSPQ), a 15-item scale, was used to assess physical emotional, intellectual, social, and spiritual wellness. Overall health was assessed by a single item. Most of the participants were positive about their overall health. Multiple regression analysis showed that physical, spiritual, and emotional wellbeing were the most significant factors (p<0.05) relating to overall health even when controlling for age, education, and income. The research suggests that these wellness dimensions may be a critical component for understanding and improving AA men’s health. Implications for improving AA men’s health through holistic, strength-based wellness will be discussed.
Abstract
Challenges to identifying and treating psychological distress and externalizing behaviors for children in foster care
APHA 2022 Annual Meeting and Expo
Objectives: Approximately half of all child welfare involved youth meet clinical criteria for a mental disorder, most commonly disruptive behaviors. Challenges with distinguishing trauma from other disorders leaves children in foster care vulnerable to misdiagnosis. This work examines diagnoses and medication experiences of youth placed in foster care.
Methods: Data were collected between in January through December of 2021 for all children deemed by the Clinical Director as in need of a clinical or neuro-psychological evaluation because of multiple failed placements or multiple psychiatric hospitalizations. Subjects were 151 high risk foster youth with open child welfare cases. Through chart review, demographic data on age, sex, and race/ethnicity were collected, along with maltreatment type, placement type, psychiatric diagnosis, hospitalizations, and psychotropic medication.
Results: Just over half of the sample was male (53.6%); average age was 12.7 years (range 7-19). Among the sample, 90% were minoritized youth. Mean number of psychiatric hospitalizations was higher for those prescribed anti-psychotic medications; no differences were found for placement type or demographics. The mean number of psychiatric hospitalizations (5.05) was significantly higher for those who had prescribed anti-psychotic medications (2.37, p= .0002). No differences were found for placement type or by demographics of assigned sex, age, race/ethnicity, or maltreatment type for either anti-psychotic diagnoses or anti-psychotic medications.
Conclusion: Findings suggesting that antipsychotics are being prescribed to treat acuity of behaviors and not necessarily the underlying problem. The acuity of behaviors among youth placed in foster care that warrant psychiatric admissions may be better explained by their exposure to trauma. Findings highlight the importance of providing evidence-based trauma informed interventions to children in foster care to help them succeed over the lifecourse and the need to establish a medical home to provide continuity of care for treatment of psychiatric symptoms.
Abstract
Learning from transgender youth and mental health care providers to design an effective mHealth training program
APHA 2022 Annual Meeting and Expo
Transgender youth face higher risks for serious mental health problems than cisgender youth and have more exposure to stress (e.g., bullying, discrimination, parental rejection). However, most mental health clinicians are not adequately trained to provide effective care to transgender patients. Over the past year, we met virtually with community advisory boards of transgender patients, trained clinicians, and untrained clinicians to design a scalable mHealth training on trans-inclusive care.
In the course of this process, we identified three unexpected problems for researchers working at the intersection of public health, social work, and technology: 1) Bad actors will attempt to disrupt social justice work via online harassment; 2) Participants who self-select to work with us already have an unusually strong (and non-representative) understanding of the subject matter; 3) Educational trainings are seen as boring at best or painful at worst. Subsequently, we have identified several lessons: 1) Implement simple, short security checks to identify and exclude those who enter our meetings with malicious intent; 2) Use neutral, general descriptions of the research aims to welcome a variety of clinicians, not only those who are positive deviants; 3) Focus educational trainings on compassion, community, and curious self-reflection to inspire the most behavioral change.
In summary, community advisory boards are essential tools for building desirable trainings; virtual meetings are accessible and effective when security measures are set up; and educational trainings can instigate deep change and maintain a positive mindset.