Executive Summary: Coalition for the Advancement and Application of Psychological Science (CAAPS) Multidisciplinary Mental Health Summit III
December 8-10, 2020
CAAPS Summit Planning Committee (in alphabetical order):
Crystal Barksdale
Kyle De Young
Theopia Jackson
Amanda Jenson-Doss
Doug Mennin
Sherry Molock
Allison Meyer
Tammy Schuler
Bethany Teachman
Summit Chair Jason Washburn
Overview:
In September 2018, the first CAAPS mental health summit was convened to discuss how a wide range of professional mental health and patient advocacy groups view evidence-based practice decision making, and to consider whether these groups could find common ground in their perspectives about evidence- based practice decision making. The 2019 summit continued this discussion with a specific focus on challenges and opportunities when applying different views of evidence-based practice decision making in the assessment and treatment of marginalized and underserved populations. This year’s summit encouraged deeper thinking on innovative service delivery models to address the needs of communities of color.
The summit was hosted virtually over three days and was open to anyone to attend. It consisted of team-led presentations with small group breakout discussions and one larger concluding discussion on the final day. Attendees were representatives from mental and medical health organizations, stakeholder groups, trainees and educators, persons with lived experience, researchers and other experts in the field, foundations, government agencies, and more. For this year’s summit, the planning committee is especially thankful to have had the assistance of several graduate student and post- doctoral discussion facilitators who helped guide the discussions and consider how to integrate these lessons into our work.
The event was co-sponsored by the Society of Clinical Child and Adolescent Psychology.
Summit Goals:
To identify innovative service delivery models to address the needs of communities of color that can be models for a future that delivers culturally relevant, evidence-informed services in ways that are scalable, based on scientific principles, and responsive to community needs.
Day 1 Presentations:
Overview of Presentations and Discussion:
Session 1: Delivering services in collaboration with non-specialist providers and lay health workers
Speakers:
Team 1: Miya Barnett, PhD, University of California, Santa Barbara; Erika Luis Sanchez, MS, University of California, Santa Barbara; Mariana Harms, MS, LMFT, Child Abuse Listening Mediation
Team 1 discussed their work using promotoras to support the delivery of Parent Child Interaction Therapy. They highlighted benefits and challenges of this work.
Team 2: Daisy Singla, PhD, Sinai Health System and the University of Toronto; Jamie Charlebois, RN, BScN, PNC(C), MScN, PMH-C, Orillia Soldiers’ Memorial Hospital and the Canadian Perinatal Mental Health Collaborative
Team 2 discussed their work taking a global health approach to developing and delivering behavioral health interventions, including a non-specialist provider delivered behavioral activation intervention for perinatal depression and anxiety.
Key takeaways included:
Increasing access to care involves thinking creatively about who provides the intervention, what the treatment consist of, where these treatments are delivered, and how we train and support implementation of our interventions.
Reverse-engineering interventions developed in global health settings to be used in Canada and the US can help address access issues here.
Lay health workers can increase supply by increasing the number of providers available and by decreasing stigma by introducing workers that are part of the community into the mental health system.
Breakout group topics:
1. Training of providers in innovative service delivery models
2. Increasing access to effective services
3. Advocacy/policy work
4. Designing and evaluating innovative service delivery models in partnership with stakeholders
Session 2: Community partnerships with a focus on Indigenous mental health
Speakers:
Deidre Begay, PhD, University of New Mexico; Leah Bogusch, PhD, University of New Mexico; Jeremiah (Jerry) Simmons, MS, University of New Mexico;
The speakers discussed their work conducting community engaged work with indigenous communities in New Mexico, their history of developing community engaged mental health programs, and the challenges that arose due to the pandemic. They also discussed creative strategies to delivering evidence-informed approaches to mental and behavioral health during COVID that are responsive and culturally informed.
Breakout group topics:
1. Training of providers in innovative service delivery models
2. Building knowledge and appreciation for diverse types of evidence to evaluate programs 3. Increasing access to effective services
4. Implementation of service delivery models with community partners
5. Evaluating community-level versus individual-level outcomes
Key takeaways included:
Conducting work from a community engaged perspective is “doing with, not for," and involves respecting and meeting the needs of the community.
Working with indigenous populations requires an awareness of both the historical trauma and resilience of the community.
Working with the dual pandemic of COVID-19 and systemic racism requires flexibility and creativity, and providers often have to work outside of the roles they were traditionally trained to take on (like providing technical support to decrease barriers).
Day 2 Presentations:
Session 1: Culture-specific care with a focus on Black mental health and anti-racism
Speakers:
Team 1: Riana Anderson, PhD, LCP, University of Michigan; Farzana Saleem, PhD, Stanford University
Team 1 discussed their EMBRace (Engaging, Managing, and Bonding through Race) model to reduce parent and adolescent racial stress through enhancing racial socialization.
Team 2: Theopia Jackson, PhD, President of the Association of Black Psychologists, Inc. (ABPsi); Tania Lodge, PhD, Minority Behavioral Health Group; Evan Auguste, Doctoral Candidate, Fordham University
Team 2, from the Association of Black Psychologists, Inc., discussed two models for supporting resilience in the Black community --Emotional Emancipation Circles and Sawubona Healing Circles-- that draw on culturally-grounded wellness strategies to cope with racial trauma and stress.
Breakout group topics:
1. Training implications: Focus on culture-specific care
2. Implementation of culture-specific care in the community
3. Building knowledge and appreciation for diverse types of evidence to evaluate programs 4. Building partnerships between researchers and community members
Key takeaways included:
Racial stress and trauma are common consequences of chronic exposure to discrimination
and important targets for intervention.
Racial socialization is a promising mechanism for supporting youth coping, reducing
parenting stress, and enhancing family functioning.
An African-centered approach can be used to defy the lie that something is wrong with Blackness and take a strengths-based approach to support coping with racial stress and trauma.
Session 2: Digital Mental Health in the time of COVID with a focus on Latinx mental health
Speakers:
Team 1: Lisa Fortuna, MD, MPH, M. Div, Zuckerberg San Francisco General Hospital and the University of California, San Francisco; Michelle Porche, EdD, University of California, San Francisco
Team 1 discussed their work testing digital interventions for youth anxiety and shared clinician and stakeholder perspectives on those interventions.
Team 2: Adrian Aguilera, PhD, University of California, Berkeley and University of California, San Francisco; Caroline Figueroa, MD, PhD, University of California, Berkeley
Team 2 discussed their work using text-based interventions to support adults’ engagement with their treatment for depression and diabetes.
Breakout group topics:
1. Training of providers in innovative service delivery models
2. Funding and sustainability of mental health services
3. Identifying mechanisms of change that make a program effective
4. Designing and evaluating innovative service delivery models in partnership with stakeholders Key takeaways included:
Despite concerns over which clients are appropriate for digital interventions, the “genie is out of the bottle” with regard to these interventions and they are likely here to stay.
Although there are racial and ethnic disparities in access to some forms of technology, smartphone access is largely equivalent across groups, suggesting that interventions involving smartphones are a promising avenue for reducing health disparities.
Text-based intervention supports are highly acceptable to many consumers and hold great potential for enhancing client engagement in treatment; there may be cultural differences in which aspects of these supports are appealing to clients.
Day 3 Discussion
Available speakers and participants from Days 1 and 2 joined in a dialogue on the topics covered during the Summit, challenges and opportunities for broader application, and potential action steps for CAAPS stemming from this Summit. Attendees were specifically asked to reflect on the following questions:
What have you learned from the presentations and discussions that you think you can apply in your own work?
What is one resource you wish you had that would contribute to advancing diversity, equity, and inclusion in your work (including increasing access to care for communities of color, if relevant)?
What do you feel you personally can contribute to advancing diversity, equity, and inclusion in your work, field, and/or community (including increasing access to care for communities of color, if relevant)?
What is one question tied to the presentations and discussions that you wish you understood better or would like to hear discussed?
Community Collaboration
Summary of major themes raised
Attendees highlighted a shift that is needed among professionals to work with and within communities to understand what they see as problems and how they would want to address them. This includes:
institutions that train future providers should reach out to the communities those individuals will serve to understand how best to prepare them;
collaboration should be both between community members and across professional disciplines (e.g., family medicine, nursing, social work, psychiatry) when designing research, including the use of community-based participatory research frameworks that explicitly include equity constructs;
thinking intersectionally and in terms of “evidence informed practices,” including valuing practice-based evidence drawn from outcome evaluation developed with consumer voices and based on community values, rather than provider perspectives;
and broadening professional networks to ensure adequate referrals when providers lack sufficient cultural competency
There was optimism expressed that partnering with stakeholders can lead to the development and broader use of culturally-specific innovative methods of healing, along with an acknowledgment that building trust is a critical first step.
Training and Resources
Attendees articulated a strong desire for a variety of trainings and resources. These included training/resources in:
ways to teach about a broader array of treatment models and outcome indicators; teaching from an anti-racist mindset; setting up curricula tied to core/foundational domains, including assessment and treatment, to better address issues related to diversity, equity, and inclusion and providing a suggested curriculum for graduate coursework to aid in influencing the next generation of students; supervising trainees to address experiences of racism and other discrimination experiences that arise or are shared in their evidence-based practice;
community participatory models (e.g., building community partnerships, grant writing for diversity and inclusion research) to make community partnerships more equitable; sensitively reaching out to form collaborations with community partners (e.g., forums where researchers and community stakeholders can connect); designing research to include a broad array of outcomes to ensure targets valued by the community are addressed;
communicating research effectively with non-scientists (policy makers, insurance companies, funders, community members, media, etc.) to advocate and effect policy change, both within our institutions and in the broader community/communities;
the EMBRace (Engaging, Managing, and Bonding through Race) model; African-centric models, including healing circles, and Black psychology;
qualitative methodologies;
reviewing grants and manuscripts with a focus on issues of diversity, equity, and inclusion;
how the history of mental health science has been harmful to the diverse majority and how
that history continues to oppress communities;
and therapy worksheets in non-English languages that may be especially important during
pandemic times.
Funding and Calls for Advocacy/Action
Attendees described opportunities to engage with sources of funding for research and public/private partnerships around the issues discussed at the summit. In particular, attendees noted:
there are government agencies that provide applicants with financial support to monetize products that could be used to generate resources for the community;
a need to increase access to research funding that isn’t specific to mental or physical health diagnoses, and is instead more amenable to work focused on sociocultural stressors, such as systemic racism;
and a need to examine local licensing laws to determine the possibility for more task-sharing efforts, work to get new evidence-informed interventions covered by insurance, improve support and recognition within training programs for students conducting community-based work.
Strengths and Opportunities for Growth
Finally, attendees noted areas of existing strengths and areas where they desire growth. Overall, attendees emphasized a humble stance combined with desire to learn and make changes as a trusted partner.
In terms of strengths, attendees reported:
having experience providing services to immigrant and refugee children in their school setting and training graduate students to provide these services and become more culturally aware;
actively seeking training opportunities to support anti-racism efforts and advocate in their professional organizations’ and institutions’ initiatives to promote diversity, equity, and inclusion and shape organizational policy;
when in positions of power (e.g., grant review panels, guideline development tasks forces, institutional administration), wielding that power with a social justice intent;
and asking questions about racial stressors and trauma in treatment; using intentional questioning to assist in getting to know patients better and help them to feel heard.
Areas where attendees desire growth included:
1. improving the dissemination and uptake of eHealth interventions;
2. ways to partner with industry to enhance awareness of effective interventions;
3. learning more about how to serve communities that are hesitant to engage in traditional Western models of psychotherapy as the chief mode of intervention;
4. deciding how to balance what a community says they need and what is supported by research evidence to be effective;
5. learning what resources the people engaged in dissemination work need to be more successful;
6. learning how non-BIPOC individuals can ally to implement or enhance the delivery of services that they cannot genuinely or authentically deliver themselves to BIPOC individuals; 7. when to adapt existing approaches in cultures for which they were not originally designed versus create new approaches from the ground up;
8. how to commit the time needed to do meaningful community based participatory research in an academic climate that may not value those activities;
9. and how to identify to active ingredients in the interventions discussed during the Summit without being reductionistic.
10. having experience building community partnerships, drawing from consumer experiences to adapt interventions to be acceptable and feasible in different cultures, and conducting community based participatory research;
11. being curious about and continuously seeking knowledge to make progress towards being an anti-racist psychologist and contribute to multi-racial spaces;
12. working to help first generation students and students from underrepresented minorities during their undergraduate training, and during the application, interview, and graduate decision making process to diversify the voices in academia;
Conclusion
The multidisciplinary mental health summit provided an opportunity to bring together many voices with the goal of identifying innovative service delivery models to address the needs of communities of color that can be models for a future that delivers culturally relevant, evidence-informed services in ways that are scalable, based on scientific principles, and responsive to community needs.
Over three days, attendees engaged with thought-provoking presentations and participated in small group discussions to consider numerous challenges and opportunities when it comes to reaching often underserved populations. The mindset of those wishing to do this work was often discussed as one that needs to be open, listening, and collaborative with community stakeholders – working with and within their communities.
In the final session, there was a productive discussion about possible next steps and ways to translate the ideas discussed during the summit into action steps.
Some potential future action steps raised by attendees include:
Bringing together researchers and stakeholders to develop more innovative ways to evaluate outcomes, including developing tools to reflect community level change/outcomes.
Working with the Association for Black Psychologists, Inc. and/or allied organizations to develop a curriculum for graduate education in Black psychology and clinical Black psychology that can be incorporated into extant graduate training as a core part of U.S. psychological training.
Initiatives to recruit and mentor more students and faculty of color and who represent sexual and gender minorities.
Joint initiatives to promote funding sources for research on culturally relevant/requested ways of healing.
Leading conversations about how the epistemological views of clinical psychology are influenced by white supremacy, and how that influences what type of evidence is accepted for categorizing practices as “evidence-based”.
Providing access to trainings in health equity.
Disseminating models of reciprocity between social advocacy/community-organizations and academia as means to increase training, awareness, and practice of equity in clinical work and research.