1. My primary research interest is in expanding access and improving effectiveness for psychological trauma interventions in historically underserved populations. I came to appreciate some of the structural issues that contribute to inequities in psychological intervention for underserved populations during my clinical psychology internship and postdoc at SFGH Dept. of Child & Adolescent Services (2014-2016). Those issues include a) limited availability of linguistically and culturally congruent trauma therapy; b) patient fears based on prior experiences of institutional collaboration/complicity with other state agencies (eg. law enforcement, immigration, child protective services) that were causes of trauma rather than trauma interventions and which can render families in vulnerable communities wary of state-funded providers; c) a history of overdiagnosis of mental disorders in communities of color and a resulting skepticism by such communities regarding the objective validity and beneficence of mental health providers and/or the conceptual bases of dominant psychological paradigms; and d) basic issues around economics, transportation, juggling work responsibilities with medical appointments when meeting basic shelter and livelihood needs isn’t assured, etc. – e.g. the challenge for parents and other caregivers escorting therapy clients to the hospital often aren't readily able to take off the time required from work to navigate multiple buses to get their child/adolescent clients to therapy appointments.
2) I’ll make a point about psychologists rather than physicians because as a psychologist that’s what I’m equipped to comment on knowledgeably. One research project that could be useful to assess the role of psychologists in maintaining/reducing disparities in access to treatment of psychological trauma is a study of structural competency training (eg. adapted from the training developed by the UCSF Rad Med collective). The study's primary hypothesis would be that a 12-week structural competency training would significantly increase child/adolescent weekly office-based psychotherapy adherence rates compared to a control group of clinicians who did not receive the training. The secondary hypothesis would be that the pre/post change in clinician's self-reported structural competency awareness would correlate positively with therapy adherence rate. The independent variable would be assignment to training vs. control group. The dependent variables would be a) the pre/post change in psychologists’ self-reported awareness of structural barriers for vulnerable populations seeking psychological trauma interventions; and b) patient therapy adherence rates. To the extent the hypotheses were supported, the study findings could inform further training implementation and dissemination efforts.