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Minority Fellowship Program Extends Training, Expands Treatment

By Rebecca A. Clay

Social worker Blanca E. Alvarado, M.S.W., has seen firsthand the misunderstandings that can occur when white health care professionals treat racial/ethnic minority patients. For example, while working in a domestic violence clinic, she was told by one of her colleagues that a Latina client was pathologically dependent. The evidence? Her mother lived with her.

"If that counselor understood our culture, she would know that we do whatever we can to keep our families together," said Ms. Alvarado, now a doctoral student in sociology and social work at Boston University. "Through all the troubles the patient was having, she was able to keep her family together. But instead of being seen as a strength, it was seen as a weakness."

Photo of mental health counseling Now Ms. Alvarado and other participants in SAMHSA's Minority Fellowship Program are working to decrease the occurrence of such misunderstandings. Celebrating its 30th anniversary this year, the Program enables the Council on Social Work Education, American Psychological Association, American Psychiatric Association, and American Nurses Association to recruit and support racial/ethnic minority students interested in doctoral and postdoctoral programs in the areas of mental health and substance abuse. SAMHSA also funds the Jeanne Spurlock Minority Medical Student Clinical Fellowship in Child and Adolescent Psychiatry at the American Academy of Child and Adolescent Psychiatry.

"The Minority Fellowship Program's goal is to facilitate the entry of ethnic minority students into mental health and substance abuse treatment training and increase the pool of minority professionals who can become leaders in the field, train the next generation, and provide services to underserved populations in our increasingly diverse society," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "The Program addresses many of SAMHSA's priorities, including cultural competency, workforce development, and co-occurring disorders."

The Program is supported by each of SAMHSA's three Centers.

Cultural Differences

Linguistic differences are the most obvious barrier to services. "You cannot deliver behavioral health services when you cannot speak the client's language," said Minority Fellowship Program Project Officer Paul Wohlford, Ph.D., a psychologist in the Division of State and Community Systems Development within SAMHSA's Center for Mental Health Services. "Having bilingual interpreters is only a partial solution. It's best to have someone who speaks the same language and understands the client's culture."

But cultures also differ at more fundamental levels. Asian Americans, for example, are often reluctant to talk openly with counselors, explained former Senior Program Manager Linda Roll, M.A., of the American Psychiatric Association. Cultures also differ in the way they define mental illness.

"People from the Philippines tend to be very superstitious," noted Ms. Roll, a Filipina herself. "I might say 'I saw my father's ghost.' Someone who's not familiar with our culture might think I'm nuts!"

And treatment traditions may be very different. Some Latinos, for example, may prefer to seek help from folk healers known as curanderos rather than from credentialed service providers.

Such differences can result in under-utilization of services for mental health and substance abuse, even when such services are available. "When institutions are perceived as culturally sterile or racially dissimilar, people don't go," explained James M. Jones, Ph.D., Director of the American Psychological Association's Minority Fellowship Program and a professor of psychology at the University of Delaware in Newark. "It doesn't make sense that people would want to go to an alien environment for help of the most intimate and sensitive nature."

According to Dr. Jones, incidents like the infamous Tuskegee Syphilis Study of 1932-1972-in which the U.S. Public Health Service studied the disease in almost 400 poor African American men without obtaining their consent, informing them of their diagnoses, or offering treatment-have fueled that mistrust.

Expanding Opportunities

It can be just as difficult to get racial/ethnic minority students to consider careers in the mental health and substance abuse fields. Like patients considering their health care options, minority students may view training programs as culturally alien. Racial/ethnic minority students may also have fewer financial resources and greater responsibilities, said Faye A. Gary, Ph.D., R.N., F.A.A.N., Ohio Medical Mutual Professor of Nursing for Vulnerable and At-Risk Populations at Case Western Reserve University in Cleveland, OH, and chair of the American Nurses Association committee responsible for the Minority Fellowship Program. "Especially with blacks, Hispanics, and Native Americans, we find that Fellows are not only responsible for their immediate families but often for their mothers, grandmothers, aunties, sisters' children, and others as well."

Photo of students The Minority Fellowship Program is designed to address these and other concerns. Although each professional society recruits its own Fellows and administers the Program a little differently, all Fellows receive a stipend that helps pay their expenses during training. Depending on the availability of funds, they may also receive tuition assistance and travel grants that allow them to attend professional meetings.

The networking that the Program facilitates is almost as important as the financial support, said E. Aracelis Francis, D.S.W., Director of the Minority Fellowship Program at the Council on Social Work Education. "The fellowship helps students network with each other so they're not as isolated as they generally are," she said. "That's especially important when you're the only person of color in a doctoral program."

Conferences, newsletters, listservs, and online chats give Fellows a sense of community. The first SAMHSA Minority Fellowship Program national conference convenes in Washington, DC, this September. Organizers anticipate that all 90 current Fellows as well as a large number of former Fellows will attend.

Ensuring that all Fellows receive training to address substance abuse as well as mental health has become a priority in recent years. "We've been energetically trying to make them aware of substance abuse as a field so they'll have another choice of career after they've completed their fellowships," said Thomas Edwards, M.A., Chief of the Systems Improvement Branch of SAMHSA's Center for Substance Abuse Treatment.

Dr. Wohlford adds, "Our goal is not only to train Fellows to practice in both fields-mental health and substance abuse-but also to equip them to treat individuals with co-occurring mental and addictive disorders."

Reaching students even earlier in their education is another priority. To achieve that goal, SAMHSA helps fund the American Academy of Child and Adolescent Psychiatry's minority medical student program. The program allows Fellows to carry out a clinical research project for up to 12 weeks with a child and adolescent psychiatrist mentor and to present their research findings at the Academy's annual meeting.

"One of the real benefits is that it turns people on to the excitement of child psychiatry, even when they weren't originally disposed toward child psychiatry or even psychiatry in general," said Virginia Q. Anthony, American Academy of Child and Adolescent Psychiatry Executive Director.

The American Psychiatric Association and American Psychological Association have launched similar programs designed to attract students to behavioral health.

Three Decades of Success

Since its inception in 1973, the Minority Fellowship Program has helped train nearly a thousand racial/ethnic minority psychiatrists, psychologists, psychiatric nurses, and social workers. Today, many of these professionals serve in key leadership positions in academia, Government, and direct service.

Marketa M. Wills, M.D., one of the American Psychiatric Association's current Fellows, hopes to follow in the footsteps of these Program alumni.

Dr. Wills isn't just using her Minority Fellowship Program award to fund her training in the Massachusetts General McLean Adult Residency Training Program. The funding also allowed her to establish a small mental health clinic within the Dimock Community Health Center in Dorchester, the heart of Boston's African American and Latino community. Supervised by a psychiatrist, she sees racial/ethnic minority patients with chronic mental illness and substance abuse. In addition, she and another Minority Fellowship Program recipient are planning a lecture series on minority mental health they hope will eventually become a book.

Dr. Wills' long-term goals include becoming the administrator of a state or local department of mental health, getting involved in policy issues affecting children, and continuing to practice at least 1 day a week-exactly the kind of future the Minority Fellowship Program is designed to promote.

For more information, visit www.mentalhealth.samhsa.gov /publications/allpubs/NMH02-0143/default.asp.

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