APAHC Grand Rounds | Fall 2019 1

GRAND

ROUNDS

In This Issue

• Letter from the guest

editor

• Social media and research

• Lessons learned in advocacy:

Cultural considerations for American

Indian suicide

• Behavioral Health services in Pediatric

subspecialties

• APA conference photos

• CFAS corner

• Board election results

Welcome from the APAHC President! Back in March 2011, I attended my first APAHC conference. Nobody suggested that I go and

nobody I knew was going. I’m not quite sure why I signed up, but I was intrigued at the pro-

spect of participating in a boot camp of other early career psychologists trying to navigate life

in an academic health center. In retrospect, it was one of the best professional decisions in

my life. Flash forward 8 years, with service on the Board of Directors in various roles, it’s a bit

surreal to realize that my 2-year term as APAHC President is coming to an end this calendar

year.

The Grand Rounds is absolutely one of the reasons I will remain connected to this organiza-

tion. Of all the professional publications I receive, it is one of the few that I read cover to cover. That’s not only a testament to

great content and editing, but also a statement of how vital I find APAHC to be to my professional identity. Clearly I’m not the

only one who thinks so: our membership has grown significantly, our biennial conference in New Orleans earlier this year was

very well reviewed, our listserv remains one of the best “hive minds” in our field, and our membership roster reads like a who’s

who in health, pediatric, rehabilitation, and clinical psychology. And yet somehow, through all the superlatives, we have built

an association that gets described as one of the most friendly and collegial out there.

It has been a real honor to work with our outstanding Board and to get to know so many of you in the process. I hope you en-

joy the latest issue of our newsletter. As always, we look forward to your input and engagement.

Zeeshan Butt, PhD

President, APAHC

Newsletter of the Association of Psychologists in Academic Health Centers Vol. 6, No. 2 Fall 2019

APAHC Grand Rounds | Fall 2019 2

https://www.oberlo.com/blog/social-media-marketing-; www.wegohealth.comstatistics www.wegohealth.com; (Globalwebindex, 2018); www.integration.samhsa.gov; Forbes.com “Can Social Media have a Positive Impact on Global Healthcare, June 5, 2018; http://www.cdc.gov/nchs/fastats/suicide.htm;

Sound Bites Related to the Newsletter:

*3.2 billion social media users with average of 2 hours, 22 minutes per day spent on social networks or mes-saging

*Twitter estimates an average 30 million active month-ly users

*60% of doctors see social media as a way to deliver better healthcare to patients & 88% of healthcare pro-viders use social media/internet to research new medi-cal information

*30,000 suicide death annually in the U.S. and ~ 1 mil-lion worldwide

*2,000 middle schoolers who experienced cyberbully-ing were ~ 2 x as likely to attempt suicide.

*The National Suicide Prevention Lifeline’s website/social platform features animated avatars in conjunc-tion with survivor stories. https://suicidepreventionlifeline.org/

*Incidence rate of 30% and 60% of mental health dis-orders among pediatric dermatology patients

*75% of youth diagnosed with a mental health disorder are seen in a primary care setting

Letter from the Guest Editor

Ashley Junghans-Rutelonis, PhD

Guest Editor

Behavioral Healthcare Pro-viders in Minneapolis, Minnesota

I am honored to have been asked to be the guest editor for the fall 2019 Grand Rounds newsletter. I joined a fantastic team (your Grand Rounds Editor-In-Chief, Lauren Penwell-Waines) and received top-notch technical support from Andrea Garroway, who made this an easy-on-the-eyes publication. What an interesting series of articles we have to share with you in this Grand Rounds. All align with the current APA focus on advancing psychology in order to benefit society and improve people’s lives. We feature the APAHC presence at the most recent APA conference and our reoccurring CFAS Corner from Laura Shaffer & Bill Robiner. We also feature an international team examining social media use and early career psychologists with great insights into research and clinical practice. Our first article elaborates on a topic we all need to be discussing – social media presence. 42% of the current worldwide population (about 3.2 billion people; Emarsys, 2019) is using social media so whether you are a fan or a foe, it is time to learn more about it. Nicole Mac-Kenzie, Perri Tutelman, Yvonne Brandelli, and Christine Cham-bers teach us about how to use social media to promote our work and how they have elevated attention to “It Doesn’t Have to Hurt,” a cam-paign to disseminate information about pediatric pain management strategies. Our second article highlights three critical areas that should be on all of our radars: championing evidence-based treatment of diverse groups, forming community relationships, and advocating for improved suicide management. Sarah Rhoades-Kerswill and Ashley Cole, two ECPs from Oklahoma, share with us their vast knowledge on best-practices concerning American Indian suicide research, prevention, and treat-ment. Lastly, Sasha Jaquez shared her experience in integrative behavioral health care and how to set-up a new team and psychology presence in a subspecialty pediatric clinic. Given the importance of psychology part-nering with our medical colleagues, this is a can’t miss article. As psychologists in academic health centers, we can lend our voices to advocating for those who are misunderstood and under-represented and can spread the evidence-based knowledge we have to our medical col-leagues and to the public. What an incredible mission for us all to get behind and advance within our own institutions! Lauren will be back in the editorial chair for your next Grand Rounds, and I know she is always on the look-out for your contributions. If you are part of a program, clinic, or research team APAHC members should know about, contact Lauren to discuss being included in the next newsletter. ~ Ashley Junghans-Rutelonis, PhD; Guest Editor

Andrea Garroway, PhD

University of Rochester

School of Medicine and

Dentistry

APAHC Grand Rounds | Fall 2019 3

Research and retweets: Using social media to promote research, col-laboration, and connections in psychology

Nicole E. MacKenzie, Perri R. Tutelman, Yvonne N. Brandelli, and Christine T. Chambers

Dalhousie University , Halifax, Nova Scotia, Canada

Social media are defined as internet-based tools

that allow individuals to connect and communicate with

other people and communities. Popular social media

platforms where researchers commonly communicate,

including Twitter, Facebook, LinkedIn, ResearchGate,

and YouTube, can provide an accessible platform to stay

up to date with new research, while also facilitating

communication with colleagues and the public. With the

ease of use, accessibility, and interactive nature of social

media, its benefits can be easily harnessed and applied to

the field of psychological research. Social media not only

provides a platform from which psychological

researchers can disseminate findings in psychological

research, but also provides a simple platform from which

to engage other researchers and knowledge users. In this

article, we review the unique ways in which researchers

in psychology can communicate, share information, and

expand their professional reach via use of social media.

Expanding Professional Reach in Research

through Social Media

Social media provides an opportunity to engage

with the broader academic community, patients,

caregivers, and advocacy groups. While research findings

are traditionally disseminated at conferences or via

publications, social media presents the unique

opportunity to connect with an audience who would be

less accessible through traditional means. Social media

also provides an interactive space to share research and

converse with others in an accessible forum. For

example, Facebook is most commonly used to engage

knowledge users in research, whereas Twitter is most

popular for reporting research findings and promoting

academic work (Dol et al., 2019). This knowledge-

sharing environment has been shown to facilitate the

exchange of high-quality information, allowing

researchers and health care providers to make informed

practice

decisions

(Rolls,

Hansen,

Jackson, &

Elliott, 2016).

Social media is

also a unique

platform by

which

researchers can

network with

existing and new colleagues.

Social networks such as LinkedIn also provide a

platform by which users can connect to consult or share

expertise, and use of such a network may present

opportunities for speaking or publication opportunities

(Tutelman, Dol, Tougas, & Chambers, 2018). Social

media presents many avenues by which researchers and

health care providers can engage with colleagues and the

public to promote existing and ongoing research.

Engagement with these groups not only facilitates an

opportunity to network with a diverse group of

individuals but provides a low-barrier option to connect

with individuals who may not have access to research

through traditional means.

Opportunities for engagement using social media

extend into use as a recruitment tool for research studies.

Research has also shown social media platforms such as

Facebook to be a cost-effective method to recruit a

diverse patient group (Akard, Wray, & Gilmer, 2015).

Recruitment via social media can be beneficial when

researchers have connections with specific individuals

and organizations, particularly when trying to recruit a

specific (and potentially hard to reach) population.

(Continued on page 4)

Photo by Merakist on Unsplash

APAHC Grand Rounds | Fall 2019 4

Research and retweets: Using social media to promote research, collaboration, and connections in psychology

Finally, social media recruitment also offers the option of

paid advertisements, where ads can be targeted toward

the demographic of interest.

Social Media for Research Dissemination

Scientific output is growing at an exponential

rate; as of 2009 there were over 50 million published

scientific articles with an estimated 2.5 million additional

new articles published each year (Jinha, 2010). Social

media has emerged as a key tool to help scientists

increase the visibility of their research, to keep up to date

with the latest advances in their fields (Dol et al.,

2019), as well as to influence policy (King,

Schneer, & White, 2017). The digital impact of a

published article can be measured using alternative

metrics (“Altmetrics”). Altmetric scores provide

information about the who, what, where and when

of how scholarly output is being shared online and

are increasingly used in tandem with more

traditional citation metrics (such as impact factors,

h-indices etc.) to quantify scholarly impact

(Gordon, Lin, Cave, & Dandrea, 2015). Scientists

can track the Altmetric scores for any scholarly

output with a digital object identifier using the free

Altmetric Bookmark tool1.

Many journals in the medical sciences

(e.g., Annals of Surgery, BMJ, JAMA, NEJM)

have now implemented “visual abstracts” in the

online dissemination of new research articles.

Visual abstracts are simple graphic depictions of the key

findings or topics covered in the article and may be

created by the journal, by the authors, or as a

collaboration between the two (see Figure 1 for an

example). A recent study compared the impact of tweets

from a journal Twitter account that included either only

the title of the article versus tweets that contained the title

and a visual abstract. Over a 5-month period, tweets with

visual abstracts had significantly higher impressions (i.e.,

views), shares, and article visits on the publishers’

website (Ibrahim, Lillemoe, Klingensmith, & Dimick,

2017). Resources for scientists interested in creating

visual abstracts for their publications have been

developed (Nikolian & Ibrahim, 2017).

Social media activities have become increasingly

important for scientific impact in academia. For instance,

there is a developing evidence base that suggests a

relationship between the dissemination of research

articles over social media (including Altmetrics scores)

and traditional measures of scholarly performance, such

as views, downloads, and citations (Allen, Stanton, Di

Pietro, & Moseley, 2013; Eysenbach, 2011; Hayon et al.,

2019; Lamb, Gilbert, & Ford, 2018); some studies have

produced mixed findings regarding the impact of citation

rates, and more longer-term comprehensive studies are

needed (Tonia, Van Oyen, Berger, Schindler, & Künzli,

2016)). Social media activities are also playing a role in

(Continued on page 5)

Figure 1. An example of a visual abstract (Tutelman et al., 2018).

1 www.altmetric.com/products/free-tools

APAHC Grand Rounds | Fall 2019 5

Research and retweets: Using social media to promote research, collaboration, and connections in psychology

academics’ promotion and tenure (Cabrera, Roy, &

Chisolm, 2018; Moher et al., 2018). In 2016 the

American Sociological Association recommended that

professors’ social media presence should contribute to

decisions regarding promotion and tenure (McCall, Smith

-Doerr, & Lamont, 2016), and since then, other scientific

organizations have followed suit (e.g., American

Anthropological Association, 2017). The Mayo Clinic

recently amended their criteria for academic

advancement to include social media and digital activities

(Cabrera, 2016), and it is likely that many more academic

institutions will consider social media activities and

public engagement as part of formal promotion and

tenure evaluations in the near future. Cabrera and

colleagues provide an outline and best practice

recommendations for developing social media portfolios

for promotion and tenure (Cabrera et al., 2017).

Building a Social Media Profile

Given the diversity of social media outlets and

the various reasons for engagement, building a

professional online profile may seem like a daunting task.

Below are some suggestions for those building and

developing their social media presence.

Prior to building a professional online profile, it

is recommended one consult with their ethical principles

and institutional policies. Various organizations have

created “best practice” recommendations for online

presence and social media use, including the American

Psychological Association and the American Medical

Association (American Medical Association, n.d.; Lannin

& Scott, 2014; Tutelman et al., 2018), including setting

privacy restrictions and using pseudonyms on personal

accounts (Lannin & Scott, 2013), and including

conversations about online boundaries with clients as a

part of the informed consent process (Tunick, Mednick,

& Conroy, 2011).

To maximize one’s social media engagement, it

is recommended that one personalize their content (i.e.,

reduce the formality and target the interest of the

intended audience), present it in a captivating way (i.e.,

use hashtags to categorize the topic, including visuals,

links, and threads when appropriate; Côté & Darling,

2018), and participate (i.e., start or join conversations

within one’s network; Center for Disease Control and

Prevention, 2011). Furthermore, it is important to post

regularly to build one’s social media presence.

A recent study by Côté and Darling (2018) found

researchers are largely followed by other researchers on

Twitter, at least until the 1000 follower mark, wherein

the audience becomes more varied (i.e., general public,

policy makers). In order to reach those diverse samples, it

is thus important to continuously nurture one’s social

media presence. How-to guides and articles exist that

detail effective strategies for writing posts and using

social media as a research tool (American Psychological

Association, 2010; Center for Disease Control and

Prevention, 2011; Kosinski, Matz, Gosling, Popov, &

Stillwell, 2015; Tutelman et al., 2018). Similarly, tools

exist that can help researchers determine the most

relevant hashtags for their message. For instance,

Symplur has developed the Healthcare Hashtag Project,

which provides a platform to connect researchers,

(Continued on page 6)

2 https://www.symplur.com/healthcare-hashtags

APAHC Grand Rounds | Fall 2019 6

Research and retweets: Using social media to promote research, col-laboration, and connections in psychology

clinicians, and the public to relevant healthcare

conversations2.

Another way to engage and build one’s reach is to

live tweet at conferences using designated conference

hashtags (e.g., #APAHC2019). Not only does this promote

networking with other attendees, it also helps disseminate

conference content beyond the physical walls of the

meeting. As an example, Collins and colleagues (Collins,

Shiffman, & Rock, 2016) found that 74% of scientists had

participated in a conference remotely via Twitter. Another

avenue for engagement are Twitter chats. These are

moderated online events organized around a particular

topic and accessed by a specific hashtag, where

researchers, clinicians, and often patients gather virtually

to discuss a topic in real time using a pre-specified hashtag

(e.g., #ThisIsHealthPsych). One way to learn about

upcoming Twitter chats is to visit Symplur, the online

social media healthcare-related database.

Examples of the Integration of Psychological

Research and Social Media

Social media also has been used as a successful

medium for knowledge translation. Dr. Christine

Chambers’ lab, at Dalhousie University, successfully

created and launched a social media campaign known as It

Doesn’t Have to Hurt (#IDHTH). Evidence-based pain

management strategies were written up in terms which

were easy for parents to understand, and disseminated

through social media accounts. #IDHTH partnered with

Yummy Mummy Club, a social media and blog site for

parents, and shared research on pain management for

children through tweets,

Facebook posts, and blog posts, using the hashtag

#ItDoesntHaveToHurt (see Figure 2). This hashtag has

now become associated with evidence-based information

on pain management for children and was a successful

enterprise in sharing health psychology research with other

professionals, academics, and parents alike. Growing from

this initiative, Dr. Chambers has also recently begun a

national knowledge mobilization network, Solutions for

Kids in Pain (SKIP) with the mission to improve

children’s pain management by mobilizing evidence-based

solutions by sharing existing evidence through

coordination and collaboration, with social media as an

outreach method.

As the scientific community continues to grow

online, it is critical for researchers to consider their place

in the social media landscape. The medium not only

provides rich opportunity to disseminate research and

promote one’s own work, but also facilitates a space where

colleagues can connect and collaborate easily and

remotely.

Figure 2. A social media post from the #ItDoesntHaveToHurt cam-paign.

(Continued from page 5)

APAHC Grand Rounds | Fall 2019 7

Laura Shaffer, PhD

President-Elect

University of Virginia

Amy Williams, PhD

Member-At-Large

Wayne State University School of Medicine

Elizabeth Cash, PhD

Secretary

University of Louisville School of Medicine

Donna LaPaglia, PsyD

Division 12 Representative

Yale University School of Medicine

Board Election Results

Terms Begin January 2020

APAHC Grand Rounds | Fall 2019 8

CFAS Corner Laura Shaffer, PhD, & Bill Robiner, PhD, APAHC CFAS Representatives University of Virginia School of Medicine; University of Minnesota Medical School The last CFAS Corner discussed the CFAS News APAHC listserv members are forwarded every week. This edition provides context for that newsletter by giving an overview of CFAS and APAHC’s involvement which is essentially Psychology’s one official presence in a national aca-demic medicine organization.

The Council of Faculty and Academic Societies (CFAS) is one of three governing

councils of the Association of American Medical Colleges (AAMC). There are approxi-

mately 350 representatives appointed by approximately 171 medical schools and 75

academic health professional societies, APAHC among them. Medical schools and

faculty organizations can each appoint two faculty representatives. APAHC is the only

CFAS member society representing psychologists. More information about CFAS and

APAHC’s involvement is available in Cubic and Shaffer (2017).

CFAS’s charge is threefold:

1) identify issues critical to faculty in medical schools

2) provide a voice concerning these issues to the AAMC to inform programs, ser-vices, and policies

3) communicate back to faculty about matters central to academic medicine and at the forefront of work at the AAMC.

CFAS Refresher

Representative Activities

Meeting Attendance. Dr. Laura Shaffer attended the

CFAS Spring Meeting in Atlanta where she and APAHC col-league Dr. Serina Neuman gave highly rated presentations on mentoring targets of sexual harassment and gender-related

macroaggressions, respectively. Both of APAHC’s represent-atives, Drs. Robiner and Shaffer, will attend the AAMC Learn, Serve, Lead meeting this November. They will present a post-

er abstract with Drs. Wendy Ward and Liz Cash on leadership roles and training needs of women psychologists in academic health centers.

CFAS Service. Beyond networking and contributing to

discussions at meetings, APAHC representatives serve on CFAS subcommittees including the Faculty Resilience and Evaluation subcommittees. Dr. Shaffer is also an appoint-

ed member of the Program subcommittee and was invited to be an abstract reviewer for Learn, Serve, Lead.

Letter Sign-Ons. The AAMC extends invitations

through CFAS to APAHC and other society members to sign on to advocacy letters. Examples of causes APAHC has supported to date include recommenda-

tions for increased NIH funding and opposition to budget cuts to NIH support for Finance and Accounting (F&A a.k.a. indirect) costs. Another example of an opportunity

to sign on was in support of the American Dream and Promise Act of 2019 (H.R. 6) or the Dream Act of 2019 (S.874) to ensure that members of the health care work-

force approved for DACA and other undocumented young people are able to continue their employment,

training, and research in the health professions. APAHC leadership and CFAS reps met with representa-tives from APA in September to develop a system for

consultation regarding how to handle future requests.

AAMC Leadership Forum. Each June, the AAMC in-

vites approximately 100 stakeholders to attend a forum con-cerning a critical issue affecting the academic medical commu-nity. Dr. Shaffer attended the 2019 Leadership Forum entitled

Reaffirming Our Commitment to Ending Gender Harassment in Academic Medicine as one of five faculty invited to represent CFAS. The forum included sessions on gender inequities in

academic medicine, allyship, organizational challenges and accountability, bystander intervention, promoting culture change, and efforts at the AAMC to address gender harass-

ment and equity in medical schools throughout the United States.

We hope this helps you better understand what we are up to as your representatives and the opportunities we have

to raise the voices of psychologists in academic health centers. Please let us keep hearing from you!

Cubic, B. A., & Shafer, L. A. (2017). Academic health center psychology representation to the Council of Faculty and Academic Societies (CFAS) of the Association of American Medical Colleges. Journal of Clinical Psychology in Medical Settings, 24, 124-131. doi: 10.1007/s10880-017-9500-4

APAHC Grand Rounds | Fall 2019 9

Who are American Indians?

It is first important to define and

contextualize American Indians. Many different

names have been used to describe the original

inhabitants of the North American continent,

including American Indian, Native American, First

Nations, Native Peoples, Aboriginal, and

Indigenous. We use American Indian (AI)

throughout, which is the term that was selected by

the National Congress of American Indians in 1944

(NCAI, 2019). Currently, there are 2.7 million

(0.8% of the U.S. population) individuals in the

U.S. who exclusively identify as AI, and 5.2 million

(1.7% of the U.S. population) individuals when

allowing for multiracial identification (Census,

2017). Currently, there are 573 federally recognized

tribes in the U.S. (BIA, 2019); thus, AIs are not a

homogenous group or culture. Furthermore, not all

tribes or nations are recognized by the federal

government. Some tribes are recognized by state

governments, whereas other tribes exist as cultural

entities without government recognition. AIs also

have distinct, rich cultures with unique perspectives

on the human

experience and ways

of relating with the

world. While we

discuss suicide and

associated risk

factors, we also wish

to impart knowledge

of AI resiliency and

strengths. Each AI

person living today

has survived in spite

of generations of

violence, trauma,

and governmental

policies aimed at

ending the AI way

of life. Hence, the

intergenerational

transmission of

resilience among AI

peoples is strong.

Trends in AI

Suicide Rates

Historically,

suicide was rare in

AI communities prior

to European contact

(Kirmayer, 1994). It

can be difficult to

obtain accurate estimates of contemporary suicide

rates for AIs because they are often misclassified as

other ethnic/racial groups (Arias, Heron, & Hakes,

2016). Of the available national statistics, the crude

rate for suicide deaths among AIs across age is

13.65 per 100,000 (CDC, 2017). A closer

examination reveals that AI young adults are

disproportionately affected by suicide, and the crude

rate for suicide deaths is 24.28 per 100,000 among

AI young adults ages 15-34 years (CDC, 2017).

Using the National Violent Death Reporting System

(NVDRS) data, approximately 10% of AI suicide

deaths occur among those between the ages 10-17

and 26% occur among those between the ages 18-24

(Leavitt et al., 2018). AIs are nearly twice as likely

to die by suicide compared to non-Hispanic White

(NHW) counterparts (Leavitt et al., 2018). AIs are

also less likely to be in current or previous mental

health treatment compared to NHWs (Leavitt et al.,

2018). The reasons why AIs, particularly AI young

adults, are disproportionately affected by suicide (Continued on page 10)

Lessons Learned in Advocacy Cultural Considerations for American Indian Suicide: Research, Prevention and Intervention

Ashley Cole, PhD; Oklahoma State University Sarah Rhoades-Kerswill, PhD; Oklahoma Tribal Mental Health Organization

Dr. Rhoades-Kerswill is currently em-

ployed at a tribal mental health organiza-

tion in Oklahoma and is a citizen of the

Kiowa Tribe of Oklahoma.

Dr. Cole is an Assistant Professor

in the Department of Psychology

at Oklahoma State University and

is a citizen of the Citizen Pota-

watomi Nation of Oklahoma.

APAHC Grand Rounds | Fall 2019 10

involve an understanding of risk factors.

Suicide Risk Factors

As is the case in general populations,

empirical work has identified the following risk

factors for suicide in AI communities: previous

suicidal behavior, poverty, being un- or under-

employed, rural settings, substance use, and feelings

of not belonging (Alcántara & Gone, 2007; O’Keefe,

Tucker, Cole, Hollingsworth, & Wingate, 2018;

Walters, Simoni, & Evans-Campbell, 2002). Among

AIs, historical trauma (also known as historical loss,

historical grief, and intergenerational trauma) has

been identified as a unique contributor to suicide risk

(Gone, 2009; Walters et al., 2002; Whitbeck, Adams,

Hoyt, & Chen, 2004). Historical trauma entails

cumulative psychological distress experienced across

generations resulting from massive group traumatic

experiences, including genocide, forced relocation,

and forced assimilation of AI peoples (Brave Heart,

1999a, 1999b). Similar to other forms of trauma,

historical trauma has been associated with increased

stress, and alcohol and substance use (Brockie, Dana

-Sacco, Wallen, Wilcox, & Campbell, 2015;

Wiechelt, Gryczynski, Johnson, & Caldwell, 2012).

Mental health research would be remiss to

exclude the effects of historical trauma. Research has

linked historical trauma with increased depressive

symptoms and suicidal thinking for AIs (Tucker,

Wingate, & O'Keefe, 2016; Tucker, Wingate,

O'Keefe, Hollingsworth, & Cole, 2016). Tucker and

colleagues (2016) demonstrated that having a strong

ethnic identity and preferring to socialize with other

AIs were each indirectly associated with increased

depressive symptoms through increased historical

loss thinking among AI young adults. In a follow-up

study, Tucker and colleagues (2016) demonstrated

that historical loss thinking indirectly influenced

suicidal ideation through increased rumination in AI

young adults. Collectively, these findings indicate

that historical trauma negatively impacts mental

health for AI young adults. It is imperative that AI

suicide prevention programs include cultural

components, such as historical trauma.

Culturally Relevant Suicide Prevention and

Intervention Efforts

While suicide rates in AIs have increased

over time, few evidenced-based suicide interventions

and treatments exist. Below, we discuss three

culturally-focused interventions/treatments to

address suicide in AI communities.

The American Indian Life Skills (AILS)

curriculum is a widely known suicide prevention

program for AIs (T. LaFromboise & Howard-Pitney,

1995). This curriculum uses a social-cognitive and

stress coping model to address avoidant styles of

coping. The program is school-based and includes

versions for middle school and high school students

(T. LaFromboise & Howard-Pitney, 1995).

Originally developed with Zuni youth, AILS has

been expanded to 56 lessons that can be tailored to

each school and/or tribe. AILS focuses on seven core

elements: building self-esteem, emotions and stress,

effective communication and problem-solving,

recognition and elimination of self-destructive

behavior, understanding why people attempt suicide,

how to help a friend who is thinking about suicide,

(Continued from page 9)

Lessons Learned in Advocacy Cultural Considerations for American Indian Suicide: Research, Prevention and Intervention

“Mental health research would be

remiss to exclude the effects of

historical trauma.”

APAHC Grand Rounds | Fall 2019 11

and planning for the future. Outcomes of the AILS

include decreased hopelessness, suicidal behavior,

and suicide. Participating in the AILS has also been

associated with increased confidence in anger

control, peer suicide intervention, problem-solving

skills, public collective esteem, stress coping skills,

community support, social resources, self-efficacy,

and self-awareness (T. LaFromboise & Howard-

Pitney, 1995; T. D. LaFromboise & Malik, 2016;

May, Serna, Hurt, & DeBruyn, 2005). While the

AILS shows promise for addressing suicide

prevention in AI populations, it is not directly a

clinical intervention.

Dialectical Behavior Therapy (DBT) is one

of the few evidence-based interventions for

targeting suicidality in youth (MacPherson,

Cheavens, & Fristad, 2013; McCauley et al., 2018).

Beckstead and colleagues (2015) adapted DBT for

American Indian/Alaska Native youth at an

inpatient substance use program. The mindfulness

activities central to DBT that were culturally

adapted included attending a weekly sweat lodge,

smudging ceremonies, and talking circles. A

spiritual counselor who attended DBT and

mindfulness implementation training also explained

traditional practices and activities as they related to

core DBT and mindfulness skills. Results of this

study demonstrated that the majority of participants

had clinically significant improvements in both

internalizing (i.e., depression and anxiety) and

externalizing (e.g., substance misuse, truancy,

school performance, and aggression) symptoms

(Beckstead et al., 2015). While this study did not

exclusively focus on treating suicidal behavior, it

provided initial utility for blending an evidence-

based treatment with cultural practices to produce

positive outcomes among AI youth.

The White Mountain Apache Surveillance

Model (WMASM; (Cwik et al., 2014; Cwik et al.,

2016) was developed in partnership with researchers

at Johns Hopkins University and has demonstrated

effectiveness for AI suicide prevention. This model

uses community-based surveillance of suicide and

suicide-related behavior, as well as case

management, to identify individuals at high risk for

suicide. A specially trained team of White Mountain

Apache tribal members collects reports of suicidal

ideation, suicide attempts, and non-suicidal self-

injury, and then follows-up with treatment referrals.

In the first five years of surveillance, the suicide

death rate was 40 per 100,000 in this community;

however, suicide death rates have been reduced by

nearly half in recent years (Cwik et al., 2014; Cwik

et al., 2016) (see Figure 1). The WMASM highlights

the large impact of community-driven suicide

prevention programs by identifying those at risk and

making treatment referrals.

(Continued from page 10)

Lessons Learned in Advocacy Cultural Considerations for American Indian Suicide: Research, Prevention and Intervention

Figure 1. Celebrating Life Prevention Program results

Cwik, M. (2017, March 31). Evaluation of the White Mountain

Apache Suicide Surveillance and Prevention System. Retrieved

online from: https://www.cps.ca/uploads/imich/B32Cwik.pdf

APAHC Grand Rounds | Fall 2019 12

Lessons Learned in Advocacy Cultural Considerations for American Indian Suicide: Research, Prevention and Intervention

What can you do? Steps for building connections

with tribal communities: 1. Contact local tribes to build collaborative partnerships. Relation-

ships are crucial in many AI communities, and trust often has to

be earned.

2. Contact local tribal or area health boards, which often serve as

liaisons between tribes and researchers. The National Indian

Health Board (NIHB) maintains a list of area health boards:

https://www.nihb.org/behavioral_health/

behavioral_health_agenda.php

3. Contact local Indian Health Services (IHS) facilities for infor-

mation on working with local tribes.

4. Review existing AI research and treatment guidelines:

• APA ethics code commentary on culturally appropriate recom-

mendations for research and practice within AI communities by

the Society of Indian Psychologists (Morse & Blume, 2013).

https://

pdfs.semanticscholar.org/1199/4b1842ff72681c38b0f980468a0

4a49fdbd9.pdf

• Guidelines for research with tribal youth by the National Con-

gress of the American Indian (NCAI, 2016). http://

www.ncai.org/policy-research-center/research-data/prc-

publications/TipsforResearchers-NativeYouth.pdf

• Principles for engaging in research with Native American commu-

nities by the University of New Mexico and several tribal commu-

nities (Straits et al., 2012). https://hsc.unm.edu/vision2020/

common/docsGuiding_Principles_Research_Native

_Communities2012.pdf

To further these aims, we recommend:

• Providing increased training and support to

early career investigators advancing research in AI

communities. For example, increasing the number of

applications for NIH Research Supplements to Pro-

mote Diversity in Health-Related Research.

• Increasing cultural knowledge in grant review

criteria and among grant reviewers.

• Ensuring that AI populations are sufficiently repre-

sented in grant-funded projects and priorities.

(Continued from page 11)

Considerations, Strategies, and

Practices for Addressing AI Suicide

Psychology and related fields (e.g., so-

cial work, public health) should cultivate addi-

tional researchers and providers to aid AI com-

munities in addressing suicide. This could be

accomplished through increased educational and

programmatic opportunities that focus on in-

creasing the number of AI students matriculat-

ing into advanced degree programs, with partic-

ular emphases on strong training in research

methodology, evidence-based practices, and

cultural knowledge. (See side bars for recom-

mendations.)

Photo credit @shanerounce

APAHC Grand Rounds | Fall 2019 13

Advocating for Behavioral Health Services in Pediatric Subspecialty Clinics

Sasha Jaquez, PhD; University of Texas at Austin, Dell Medical School

It is well known that behavioral and physical

health needs are largely interrelated; however, obtain-

ing behavioral health care can still be challenging for

many patients. Integrated behavioral health (IBH) rec-

ognizes both medical and behavioral health are im-

portant to well-being and strives to provide services in

one setting for all factors (Agency for Healthcare Re-

search and Quality, n.d). While there is a strong push

to integrate behavioral health services into primary

care settings, integrating into pediatric subspecialty

clinics is lagging. With an estimated one-fifth of all

youth having a diagnosable psychiatric disorder, it is

common for youth to be referred to subspecialty clin-

ics where they present with untreated behavioral

health concerns and comorbid physical health condi-

tions. This leads to the need for IBH models in pediat-

ric subspecialty clinics (Williams, Klinepeter, Palmes,

Pulley, & Foy, 2004). While different models for inte-

gration of IBH into subspecialty clinics do exist, there

are significant gaps in their implementation and use

despite an identified need for providing behavioral

health care to youth presenting with comorbid behav-

ioral and physical health conditions (Samsel, Ribeiro,

Ibeziako, & DeMaso, 2017). Integrating or adding

behavioral health care into an existing medial system

requires change across administration, workforce, and

clinical operations (SAMHSA-HRSA, n.d). Below are

steps to consider when exploring integrating into pedi-

atric subspecialty clinics.

First, time should be spent at the administration level

to ensure IBH services will fit in the mission statement

and work plan of the existing medical model

(SAMHSA-HRSA, n.d). This includes buy-in from

clinic/hospital administration and medical providers

and identification of sustainability to support IBH in-

clusion. Once these have been identified, other logis-

tics related to fitting an additional specialty into an ex-

isting subspecialty clinic can be addressed. Types of

service models and levels of integration should be con-

sidered and agreed upon by all those involved.

Next, it is important to identify IBH provider

specifics and how they will be added to the workforce.

If an existing behavioral health provider is identified

who will engage in program development, it is impera-

tive to discuss productivity expectations and ramp-up

time. If not, work on getting the position approved and

posted for hire (SAMHSA-HRSA, n.d). In the mean-

time, additional support staff should be identified for

scheduling and insurance verifications, as these pro-

cesses are often significantly different than for medical

providers. Clinic logistics such as space and initial

resources should be discussed and agreed upon. This

is also a great time for an IBH provider to share, with

the medical team, other possibly overlooked services

(e.g., school advocacy and support, implementing

screenings, or research and training).

Sasha Jaquez, PhD; Pediatric Psychologist’; Assistant Professor of

Psychiatry, Dell Medical School and Assistant Clinical Professor, Edu-

cational Psychology, University of Texas at Austin

APAHC Grand Rounds | Fall 2019 14

Advocating for Behavioral Health Services in Pediatric Subspecialty Clinics

Once administration and clinic logistics have

been appropriately managed, the behavioral health

provider should begin to integrate onto the team. Inte-

gration might include spending time shadowing the

medical provider to gain a better understanding about

the subspecialty clinic and offering behavioral health

consults to medical providers on difficult cases. Being

a new behavioral health provider in a subspecialty

clinic may be overwhelming at times, but reaching out

to other providers in similar subspecialty clinics can

be invaluable. Collaboration will build professional

networking opportunities and allow the behavioral

health provider to learn from others in the field. For

more details and a flow chart, see SAMHSA-HRSA

Center for Integrated Health Solutions’ Quick Start

Guide to Behavioral Health Integration.

Sub-

specialty

clinic IBH

implemen-

tation can

look differ-

ently in

more es-

tablished

partner-

ships, like

with gastroenterology (Lamparyk, Debeljak, Aylward,

& Mahajan, 2018), or in areas like hematology/

oncology which have documented standards of care

(Wiener, Kazak, Noll, Patenaude, & Kupst, 2015).

Still other clinics, like dermatology and allergy

(Klinnert et al., 2018), are newer to IBH and have less

available research about needed behavioral health sup-

port. However, research continues to support that

families report increased satisfaction when IBH ser-

vices are offered early in medical or surgical treatment

and hospitalization (Kitts, Gallagher, Ibeziako, Bu-

joreanu, Garcia, DeMaso, 2013; Lavakumar, Gaste-

lum, Choo, Gerkin, Kahn, Lee, et al., 2015), suggest-

ing support for increased integration and sooner con-

tact with behavioral health providers, including in pe-

diatric subspecialty clinics.

APAHC was honored to have Dr. Catherine Grus pre-

sent the APAHC address at APA this year. Dr. Grus is the

Acting Chief Education Officer at APA where she has been

on staff since 2005. In this role she leads the association’s

efforts to promote psychology in education and education in

psychology. She has been instrumental in efforts related to

advancing interprofessional education for psychology stu-

dents, primary care practice, competency assessment, and

supervision. Dr. Grus is a tremendous ambassador for psy-

chology in health professions education and serves on the

National Academy of Medicine’s Global Forum on Innova-

tions in Health Provisions Education, Interprofessional Pro-

fessionalism Collaborative, and Federation of Associations

of Schools of Health Professions.

In her address, The Education and Training Land-

scape: Current and Future Possibilities, Dr. Grus explored

current trends impacting psychology education and training.

Changes in technology such as the digitalization of libraries,

development of telehealth, and big data are shaping how

psychologists train, practice, and research. The move to

competency based education also has significant implica-

tions. According to the APA Center for Workforce Studies,

27% of health service psychologists identified hospitals or

medical centers as their primary work settings. In addition

to continuing efforts to train learners to be interprofessional

team players, there is a need to train psychologists to lower

health care costs, assist with implementation of value based

care models, and work to improve population health. Col-

laborative efforts to improve competence in interprofession-

al professionalism and practice include the Interprofessional

Professionalism Collaborative involving psychology and 11

health care professions, the development of the IPP toolkit,

IPEC competencies and primary care competencies. Last is

the trend to embrace the full continuum of psychology train-

ing to better address the shortage of mental health profes-

sionals and expansion of other mental health disciplines. To

this end, APA is moving forward with accreditation of mas-

ters programs and is developing tools such as the Individual

Development Plan available on the APA website to help

learners chart their psychology careers. These are just some

of the boundless opportunities facing psychology training

and education as the health care landscape continues to

evolve.

(See images on page 15)

APAHC at APA: Dr. Catherine Grus’ “The Education and Training Landscape: Current and Future

Possibilities” Laura Shaffer, PhD;

University of Virginia School of Medicine

Photo by Ryoji Iwata, Upsplash

APAHC Grand Rounds | Fall 2019 15

Thank you to the following for their picture contributions: Lance Anderson on

UpSplash for the Chicago image, Sharon Berry, Ashley Junghans-Rutelonis,

Amit Shahane

Dr. Catherine Grus discussing the Education and Training Land-

scape—Current and Future Possibilities

Chicago—the host of the 2019 APA Conference

Drs. Ashley Junghans-Rutelonis, Sasha Jaquez, and Jason Boye

after their presentation discussion program development in children’s

hospitals.

Ron Rozensky was pre-

sented with the Fowler

Award for dedication to

advancing the APA mis-

sion by APA President

Rosie Phillips Davis. Dr.

Rozensky is also pic-

tured here with Drs Sha-

ron Berry and Steve

Tovian.

Drs. Sharon Berry and Lisa Kearney enjoying their time at APAHC.

APAHC Grand Rounds | Fall 2019 16

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APAHC Grand Rounds | Fall 2019 18

Call for proposals and editorial staff!

Have exciting clinical research that you want to share?

Using innovative teaching methods?

Involved with policy?

Let APAHC members know what you’re doing!

We are seeking submissions of approximately 500—1,000 words for upcoming in-stallments of Grand Rounds. We also are looking for editorial staff to help publish

future issues.

E-mail your proposals to the Editor at apahc.association@gmail.com

Connect with us!

Visit our website at https://ahcpsychologists.org/

Follow us on social media @APAHCnews