1. Training Psychologists in Clinical Work with Triply Stigmatized Youth: Ethnic Minority, Sexual Orientation Minority, and HIV-Positive The Adolescent Initiative at The Childrens Hospital of Philadelphia Jerilynn Radcliffe, PhD, ABPP – Psychologist Linda A. Hawkins, MSEd – Mental Health Counselor

2. Training Needs Youth with HIV are a rapidly increasing clinical population. Youth with HIV are a rapidly increasing clinical population. CDC (2008). Largest increases in HIV diagnoses among youth of color below the age of 25, especially sexual minority males, a triply stigmatized group within contemporary U.S. society. CDC (2008). Largest increases in HIV diagnoses among youth of color below the age of 25, especially sexual minority males, a triply stigmatized group within contemporary U.S. society. Health needs of youth with HIV significant: Health needs of youth with HIV significant: Adherence to medical care and medication Adherence to medical care and medication Wide range of medical complications Wide range of medical complications Lifestyle modifications required, but difficult Lifestyle modifications required, but difficult Social impact within families and communities Social impact within families and communities

3. Plan for Todays Talk Describe the training areas available when working with youth living with HIV Describe the training areas available when working with youth living with HIV Present our approach to training future psychologists in effective work with these youth Present our approach to training future psychologists in effective work with these youth Share resources weve found helpful Share resources weve found helpful

4. Areas for Training HIV as a disease and stigmatizing condition HIV as a disease and stigmatizing condition Cultural sensitivity for ethnicity, HIV stigma, sexual orientation diversity Cultural sensitivity for ethnicity, HIV stigma, sexual orientation diversity Disclosure and adherence issues Disclosure and adherence issues HIV-related family disruptions HIV-related family disruptions Mental health problems: depression, post- traumatic stress Mental health problems: depression, post- traumatic stress Legal and ethical issues Legal and ethical issues Effective participation in multidisciplinary care team Effective participation in multidisciplinary care team

5. Training Methods Case Review Case Review Journal Club Journal Club Mental health screenings Mental health screenings Hands on training in outreach, engagement Hands on training in outreach, engagement Group counseling participation Group counseling participation In vivo and audiotaped sessions In vivo and audiotaped sessions Participation in clinic-based mental health research Participation in clinic-based mental health research Formal presentations Formal presentations

6. Case Review Weekly multidisciplinary team meeting where all patients to be seen that week are presented, discussed, and planned for. Weekly multidisciplinary team meeting where all patients to be seen that week are presented, discussed, and planned for. Incorporates medical, nursing, social work, mental health, wellness counseling, and research planning Incorporates medical, nursing, social work, mental health, wellness counseling, and research planning Follow-up discussions of all patients seen the week prior are also held in Case Review. Follow-up discussions of all patients seen the week prior are also held in Case Review.

7. Journal Club Meets monthly, one hour Meets monthly, one hour Mental health team members, including all psychology trainees Mental health team members, including all psychology trainees Leadership rotates among all participants Leadership rotates among all participants Topics selected according to current clinical and research interests Topics selected according to current clinical and research interests

8. Outreach, Engagement In vivo demonstrations of effective outreach techniques of youth In vivo demonstrations of effective outreach techniques of youth Case conceptualizations Case conceptualizations Shadowing psychiatry Shadowing psychiatry Role-playing Role-playing Community based learning Community based learning Movies, television shows, music, popular press Movies, television shows, music, popular press

9. Mental Health Screenings Standard of care: Yearly Beck Depression Inventory-II screens Standard of care: Yearly Beck Depression Inventory-II screens Optional for cognitive status: Wechsler Abbreviated Scale of Intelligence Optional for cognitive status: Wechsler Abbreviated Scale of Intelligence Yearly mental health check-in Yearly mental health check-in

10. Therapy/Counseling Psychotherapy with individual youth re adjustment to illness, psychosocial stressors Psychotherapy with individual youth re adjustment to illness, psychosocial stressors Participation in monthly peer group meetings as invited co-leader or presenter Participation in monthly peer group meetings as invited co-leader or presenter

11. Supervision Modalities Audiotaped sessions Audiotaped sessions In vivo sessions with mental health professionals In vivo sessions with mental health professionals Weekly case conceptualizations Weekly case conceptualizations

12. Participation in Clinic-Based Research Trainees participate in the design, implementation, and analysis of research findings. Trainees participate in the design, implementation, and analysis of research findings. Recent studies Recent studies Post-traumatic stress Post-traumatic stress Spirituality and religiosity Spirituality and religiosity Transition to adult care Transition to adult care Sexual health risk Sexual health risk

13. Presentations Leadership in Neurodevelopmental Education (LEND) Leadership in Neurodevelopmental Education (LEND) Posters and oral presentations of research Posters and oral presentations of research Graduate Professional Education (GPE) Graduate Professional Education (GPE) Presentation on Program to Departmental Psychology Seminar Presentation on Program to Departmental Psychology Seminar Professional Presentations Professional Presentations

14. HIV Disease Resources HIV as a disease HIV as a disease Kalichman, S. (1998). Understanding AIDS, Second Edition. Washington, DC: American Psychological Association. Kalichman, S. (1998). Understanding AIDS, Second Edition. Washington, DC: American Psychological Association. Bartlett, J. & Finkbeiner, A. (2006). The Guide to Living with HIV. Baltimore, MD: The Johns Hopkins University Press. Bartlett, J. & Finkbeiner, A. (2006). The Guide to Living with HIV. Baltimore, MD: The Johns Hopkins University Press.

15. Cultural Sensitivity Resources R. Savin-Williams (2001). Mom, Dad, Im Gay: How Families Negotiate Coming Out. Washington, DC: APA. R. Savin-Williams (2001). Mom, Dad, Im Gay: How Families Negotiate Coming Out. Washington, DC: APA. DAugelli, A.R., & Patterson, C.J. (2001). Lesbian, Gay, Bisexual Identities and Youth: Psychological Perspectives. New York: Oxford University Press. DAugelli, A.R., & Patterson, C.J. (2001). Lesbian, Gay, Bisexual Identities and Youth: Psychological Perspectives. New York: Oxford University Press. Ryan, C., & Futterman, D. (1997). Lesbian and Gay Youth: Care and Counseling. Adolescent Medicine: State of the Art Review, 8(2). Philadelphia, PA: Hanley & Belfus, Inc. Ryan, C., & Futterman, D. (1997). Lesbian and Gay Youth: Care and Counseling. Adolescent Medicine: State of the Art Review, 8(2). Philadelphia, PA: Hanley & Belfus, Inc.

16. Cultural Sensitivity Resources African American African American Weston, K. (1991). Families We Chose: Lesbians, Gays, Kinship. New York: Columbia University Press. Weston, K. (1991). Families We Chose: Lesbians, Gays, Kinship. New York: Columbia University Press. Boykin, K. (1996). One More River to Cross: Black & Gay in America. New York: Doubleday Press. Boykin, K. (1996). One More River to Cross: Black & Gay in America. New York: Doubleday Press. Myrick, R. (1999). In the Life: Culture-specific HIV communication programs designed for African American men who have sex with men. The Journal of Sex Research, 36(2), 159-170 Myrick, R. (1999). In the Life: Culture-specific HIV communication programs designed for African American men who have sex with men. The Journal of Sex Research, 36(2), 159-170

17. Cultural Sensitivity Resources Latina Women Latina Women Lijtmaer, R. (1998). Psychotherapy with Latina Women. Feminism & Psychology, 8(4), 537-543. Lijtmaer, R. (1998). Psychotherapy with Latina Women. Feminism & Psychology, 8(4), 537-543. Youth Youth Luna, G.C. (1997). Youths Living with HIV: Self-Evident Truths. Binghamton, NY: Hawthorn Press. Luna, G.C. (1997). Youths Living with HIV: Self-Evident Truths. Binghamton, NY: Hawthorn Press. http://www.advocatesforyouth.org/ http://www.advocatesforyouth.org/ http://www.advocatesforyouth.org/

18. Cultural Sensitivity Resources Transgender Individuals Lev, A.I. (2004). Transgender Emergence: Therapeutic Guidelines for Working with Gender- Variant People and Their Families. New York, NY: The Haworth Clinical Practice Press Lev, A.I. (2004). Transgender Emergence: Therapeutic Guidelines for Working with Gender- Variant People and Their Families. New York, NY: The Haworth Clinical Practice Press Coleman, E., Bockting, W., & Kirk, S. (2001). Transgender & HIV: Risks, prevention and care. Binghamton, NY: Hawthorn Press. Coleman, E., Bockting, W., & Kirk, S. (2001). Transgender & HIV: Risks, prevention and care. Binghamton, NY: Hawthorn Press.

19. Mental Health Resources HIV-related mental health issues for youth HIV-related mental health issues for youth Donenberg, G., & Pao, M. (2005). Youths and HIV/AIDS: Psychiatrys role in a changing epidemic. Journal of the American Academy of Child & Adolescent Psychiatry, 44(8), 728- 747. Donenberg, G., & Pao, M. (2005). Youths and HIV/AIDS: Psychiatrys role in a changing epidemic. Journal of the American Academy of Child & Adolescent Psychiatry, 44(8), 728- 747. OConnor, M. (1997). Treating the Psychological Consequences of HIV. San Francisco, CA: Jossey-Bass. OConnor, M. (1997). Treating the Psychological Consequences of HIV. San Francisco, CA: Jossey-Bass. http://mentalhealthAIDS.samhsa.gov http://mentalhealthAIDS.samhsa.govhttp://mentalhealthAIDS.samhsa.gov

20. Legal & Ethical Resources Pope, K., & Vasquez, M.J.T. (2007). Ethics in Psychotherapy & Counseling: A Practical Guide. San Francisco, CA: Jossey-Bass. Pope, K., & Vasquez, M.J.T. (2007). Ethics in Psychotherapy & Counseling: A Practical Guide. San Francisco, CA: Jossey-Bass. Anderson, J.R., & Barret, B. (2001). Ethics in HIV-related Psychotherapy: Clinical Decision Making in Complex Cases. Washington, DC: American Psychological Association. Anderson, J.R., & Barret, B. (2001). Ethics in HIV-related Psychotherapy: Clinical Decision Making in Complex Cases. Washington, DC: American Psychological Association.

21. What Weve Learned Importance of both formal and informal learning experiences Importance of both formal and informal learning experiences Value of summarizing the experience through formal presentations Value of summarizing the experience through formal presentations Clinical work and research offer important and complementary learning opportunities Clinical work and research offer important and complementary learning opportunities

22. Plans for the Future Continue to develop library of resources for trainees Continue to develop library of resources for trainees Involve trainees in advocacy on behalf of HIV-infected youth throughout the City of Philadelphia Involve trainees in advocacy on behalf of HIV-infected youth throughout the City of Philadelphia

23. Deepest Appreciation Graduate Program in Psychology Graduate Program in Psychology Project HOPE (American Psychological Association) for ongoing support around HIV-specific training Project HOPE (American Psychological Association) for ongoing support around HIV-specific training APA-approved Internship Program at CHOP (Paul Robins, PhD & Mary Rourke, PhD, Co-Directors) APA-approved Internship Program at CHOP (Paul Robins, PhD & Mary Rourke, PhD, Co-Directors) Postdoctoral Fellowship Program at CHOP (Melissa Alderfer, Director) Postdoctoral Fellowship Program at CHOP (Melissa Alderfer, Director)