Partnerships for Mental Health Narratives of Community and

Academic Collaboration

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Editors
Laura Weiss Roberts, MD, MA Daryn Reicherter, MD
Department of Psychiatry Department of Psychiatry
and Behavioral Sciences and Behavioral Sciences
Stanford University School of Medicine Stanford University School of Medicine
Stanford, CA, USA Stanford, CA, USA

Steven Adelsheim, MD Shashank V. Joshi, MD

Department of Psychiatry Department of Psychiatry
and Behavioral Sciences and Behavioral Sciences
Stanford University School of Medicine Stanford University School of Medicine
Stanford, CA, USA Stanford, CA, USA

ISBN 978-3-319-18883-6 ISBN 978-3-319-18884-3 (eBook)

DOI 10.1007/978-3-319-18884-3

Library of Congress Control Number: 2015946564

Springer Cham Heidelberg New York Dordrecht London

© Springer International Publishing Switzerland 2015
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To Eric and our family
—Laura

To Amelia, Ethan, and Heidi: you are the

wind in my sails and you inspire me to try to
make the world a better place for all.
—Daryn

To my wife, Tara, whom I met in a community

collaborative meeting. Through both your
work and personal interactions, you continue
to daily teach me the true meaning of
community partnership.
—Steve

To the schools in the San Francisco Bay Area

that we have been privileged to walk
alongside of and grow with. A special thanks
to Malathy, Aanand, Amrit, and Sanjan for
their loving support and for tolerating the
many late-night arrivals after community
meetings.
—Shashank
Foreword

Partnerships Between Academic Medical Centers

and Community-Based Organizations Enhance
the Mission and Impact of Each

To address the complexity of modern challenges and opportunities, partnerships are

increasingly important in a variety of different disciplines. This book presents
meaningful and moving examples of partnerships between members of academic
medical centers (AMCs) (e.g., faculty, students, and staff) and community-based
organizations (e.g., clients, patients, leaders, volunteers, and workers). The exam-
ples described in these chapters provide tangible evidence of the positive impact
that these partnerships have had, and continue to have, on the health and welfare of
individuals and communities.
I am particularly pleased and grateful that many of the community partnerships
described in this book have been developed by Stanford faculty. I also appreciate the
role of Dr. Laura Weiss Roberts, Chairman of the Department of Psychiatry and
Behavioral Sciences at Stanford University School of Medicine, and her departmen-
tal colleagues, Drs. Daryn Reicherter, Steven Adelsheim, and Shashank Joshi, in
encouraging these partnerships and in editing this book.
AMCs have had a critically important role in virtually all major biomedical
advances over the past century. The groundbreaking report of Abraham Flexner in
1910 [1] identified the need for a scientifically based curriculum in medical schools.
The implementation of recommendations from the Flexner report led to the forma-
tion of AMCs with tripartite and interrelated missions of patient care, research, and
teaching. Diagnosis and treatment of diseases were advanced, innovations abounded,
and patient care improved—particularly for patients with acute illnesses who were
treated within the four walls of a hospital. Communities have certainly benefitted
from the Flexner revolution, but only more recently have AMCs viewed outreach to
communities and partnerships with community-based organizations as an integral
part of their broad mission to improve human health.

vii
viii Foreword

As we look to the future, community partnerships, such as those described in this

book, will be of increasing importance to the core mission of AMCs, which is
evolving to focus on a broader view of health as something more than just medical
care for acute illnesses. This mission is evolving for at least three reasons. First,
many scientific opportunities compel us to look at the mission of an AMC as being
broader than the diagnosis and treatment of disease. We now have within our grasp
the opportunity to make major advances in the prediction and prevention of disease,
thereby adding a new dimension to the scope of engagement and impact of AMCs.
Second, integrated and coordinated approaches over long periods of time are
required to provide effective care for patients with multiple medical problems. This
need compels us to broaden our scope of focus to include effective care for patients
with chronic diseases in addition to our traditional focus on acute diseases. Third, as
expressed in a number of ways, society now expects all of us involved in the deliv-
ery of health care in America to be much more focused on value (e.g., improved
outcomes at lower cost).
Community partnerships will be essential for success in each of these areas.
Collaboration with community partners is needed to promote well-being and stop
disease before it starts—from providing local screenings to ensuring vaccine com-
pliance. As more and more individuals cope with chronic disease, community ini-
tiatives increasingly provide programs that support healthy habits, like smoking
cessation and exercise—areas often forgotten in the provision of medical care.
Finally, as we work toward improving value in health care, greater coordination
across medical and social and community service providers will play a key role in
sustaining long-term health in a cost-effective manner.
Another factor that is pushing AMCs toward increasing community partnerships
is an increased awareness of the social determinants of health—the conditions in
which we are born, live, and work—and the prominent and yet often unacknowl-
edged role these conditions play in our well-being. Abraham Flexner himself recog-
nized the importance of social factors, asserting that physicians have the duty “to
promote social conditions that conduce to physical well-being” [1, p. 68]. The func-
tion of a physician, he noted more than a century ago, “is fast becoming social and
preventive, rather than individual and curative” [1, p. 26].
The programs and activities described in each of the chapters of this book pro-
vide compelling examples of passionate commitment, unfailing optimism, and
steadfast persistence. We learn about Lawrence McGlynn’s personal journey as a
boy growing up in the San Francisco Bay Area during the early years of the HIV
epidemic [2]. McGlynn’s perspectives evolve during his transitions to medical
school, residency in psychiatry, and appointment as a faculty member. His desire to
improve the lives of those with HIV and methamphetamine addiction and to bring
the epidemic into check led him to provide care to patients at the Partners in AIDS
Care and Education (PACE) Clinic in San Jose and the Positive Care Clinic at
Stanford. In addition to the care he provides as a psychiatrist, McGlynn has been
involved in educating health care workers and community members about the link-
age between methamphetamine addiction and HIV. His work has also included
studies and interventions aimed at reducing methamphetamine use.
Foreword ix

Suzanne Walker and Victor Carrion [3] describe the effects of chronic stress and
trauma on the health of children and youth in a San Francisco community. A dose–
response relationship has been demonstrated between adverse childhood experi-
ences (including physical neglect and abuse, emotional neglect and abuse, sexual
abuse, and substance abuse in the household) and adult risk of chronic disease.
Walker, Carrion, and their colleagues developed the Center for Youth Wellness with
collocated pediatric medical and mental health services as a part of a federally qual-
ified heath center in Bayview Hunters Point (a residential neighborhood of San
Francisco that has experienced high rates of poverty, community violence, and
adverse environmental exposure). They found that 12 % of the children in this com-
munity were affected by four or more adverse childhood experiences, and 51 % of
these children were identified as having learning and behavioral problems. Evidence-
based therapies have been developed through partnerships that include teachers,
pediatricians, psychiatrists, dentists, and nutritionists.
On the international front, the chapter of the book written by Jayne Fleming and
Daryn Reicherter [4] describes how a group of physicians and human rights lawyers
came together to send a legal-medical delegation to Haiti a month after the devastat-
ing magnitude 7.0 earthquake in 2010. Reicherter, a psychiatrist and recognized
expert in cross-cultural trauma, led the medical team. Fleming, a pro bono attorney
at Reed Smith LLP, led the legal team. They and their colleagues went to Haiti to
understand the human rights situation and to identify individuals who might qualify
for evacuation due to extraordinary circumstances, such as medical conditions that
could not be treated in Haiti. Thirty-seven candidates for humanitarian parole were
identified during their first visit, all of whom were victims of rape and suffered from
posttraumatic stress disorder.
This first visit to Haiti led to an enduring commitment, and volunteers with the
Haiti Humanitarian Project have since made about 30 more trips to the country, work-
ing closely not only with community groups but also with the United Nations High
Commissioner for Refugees. When faced with financial and logistical challenges on
the ground, the team has persevered and developed innovative solutions. They have
used cutting-edge telehealth technology to help assess whether or not people met
criteria for refugee status. By late 2014, the group had succeeded in permanently
resettling 52 Haitian women and children in the United States and Canada.
The partnerships described in this book provide an exciting glimpse into the trans-
formative effects of partnerships between communities and the faculty, students, and
staff at AMCs. I have focused on three of the narratives, but each story provides
unique understanding of how collaboration can bring about positive change.
Such improvement is urgently needed, as there remains much room for improve-
ment on the health care landscape. The United States has some of the best hospitals
in the world, and American patients have earlier access to cutting-edge drugs and
treatments and generally shorter waiting times to see physicians. But on broad mea-
sures of health outcomes like infant mortality and life expectancy, the United States
ranks near the bottom among the countries belonging to the Organization for
Economic Coordination and Development. Moreover, improvement on these types
of indicators is slower in the United States than in most other nations.
x Foreword

AMCs have an important role in addressing these shortcomings. To realize our

potential, we need to expand our mission beyond care to include health—and not
just for individuals but also for communities. By partnering with community-based
organizations, AMCs are increasingly focusing on prevention, chronic disease,
health care value, the social determinants of health, and other significant factors that
contribute to human health and well-being on a broad scale.
We live in a time of enormous potential for biomedical discovery and improve-
ments in human health. Collaboration between community and academic partners
will play a critically important role in realizing this potential. The collaborations
highlighted in this book are inspired examples of what can be accomplished.

Lloyd B. Minor, M.D.

References

1. Flexner A. Medical education in the United States and Canada: A report to the Carnegie
Foundation for the Advancement of Teaching. New York: The Carnegie Foundation for the
Advancement of Teaching; 1910.
2. McGlynn LM. The Stanford–Santa Clara County Methamphetamine Task Force. In: Roberts
LW, Reicherter D, Adelsheim S, Joshi S, editors. Partnerships for mental health: narratives of
community and academic collaboration. New York: Springer Science+Business Media, LLC;
2015.
3. Walker SE, Carrion VG. The Center for Youth Wellness: A community-based approach to
holistic health care in San Francisco. In: Roberts LW, Reicherter D, Adelsheim S, Joshi S, edi-
tors. Partnerships for mental health: narratives of community and academic collaboration.
New York: Springer Science+Business Media, LLC; 2015.
4. Fleming JE, Reicherter D. The earthquake. In: Roberts LW, Reicherter D, Adelsheim S, Joshi
S, editors. Partnerships for mental health: narratives of community and academic collaboration.
New York: Springer Science+Business Media, LLC; 2015.
Preface

I lived in New Mexico 10 years before I wore a western-style belt, so deep was my
intention to not appear other than what I was—a kid from Chicago who loved the
sky, the mountains, the high desert, and the green chile of New Mexico.
I trained and worked at the medical school, and each year I marveled at the
young physicians who would come and, within days of their arrival, don tall cowboy
hats and boots, denim of a particular cut, and silver and turquoise. These men and
women would come for adventure, enticed by what was novel to them in this large,
sparsely and diversely populated frontier. These young healers came to New Mexico
promising to learn and to dedicate their efforts to a place rich with poverty, need,
and risk. Some of these young physicians stayed (usually trading their initial
Southwest costume for a more subtle bolo tie or earrings). And yet, many of these
same men and women would leave. They were unhappy with all that was unfamiliar
to them. They were exhausted by the demands of a rural, relentlessly resource-poor
place. Commitments made to individuals and to the communities of New Mexico no
longer held, and, the sense of promise was no longer felt.
A second, more positive observation from this formative time in the Southwest
relates to the ingenuity that arises in situations of overwhelming need and few
resources. A great example is a program developed decades ago by a child psychia-
trist from the university who was working in a frontier community in which many
adolescent girls were becoming pregnant and dropping out of school. These young
mothers and their children were experiencing tremendous mental and physical
health challenges. Most were not doing well at all. Their futures were becoming
diminished and the entire community was affected. Efforts by teachers and local
leaders to “educate” young people about birth control and pregnancy over many
years were essentially ineffective. Working with the community, the psychiatrist
came up with an idea: to develop a toddler care program and, in this carefully super-
vised setting, to employ young teenage girls as the caregivers. Through one initia-
tive, many of the older adolescent mothers in the community were able to return to

xi
xii Preface

school, bringing far more salutary outcomes to their families. But another effect was
felt among the adolescent girls working in the toddler program: seeing how difficult
it was to take care of little kids, the teenagers made considerable efforts to avoid
becoming pregnant. The pattern was disrupted.
Another great example of necessity as the “mother of invention” was a collabora-
tion over nearly two decades that has brought together state, county, and university
partners to address the overwhelming needs of elders who reside in remote areas
throughout New Mexico and have serious mental illnesses, such as depression, anx-
iety, late-life psychosis, and dementia. Few resources exist for this greatly burdened
special population of New Mexico. New Mexico is the fifth-largest state in the
United States, with 0.6 % of the country’s population, so most of the state qualifies
as truly frontier (i.e., fewer than 6 people per square mile), and it has few clinics,
hospitals, and health professionals. New Mexico also is economically distressed,
currently ranked 48 out of 50 states with respect to fiscal health, with one in five
individuals living below the poverty line. And New Mexico, like other rural states,
has an overrepresentation of children, elders, and disabled individuals. Alone, the
state could never do enough. The counties could never do enough. The university
could never do enough. Together, however, the three partners could bring different
elements from which an effective program could be, and was, built. The state con-
tributed resources, novel solutions for reimbursing home-based care, and network-
ing with a broader system; the counties contributed local clinic and generalist
clinician efforts; and the university contributed subspecialty expertise, clinical
trainees, continuing education, and respite support. In this program, a circuit-riding
faculty physician traveled the state—working side-by-side with community-based
colleagues, performing clinic, home, and video visits with rural elders and their
families, and training physicians interested in rural health care.
My work in academic-community partnering has evolved since my early days in
New Mexico and, even before, in urban underserved communities of Chicago. I
have had the privilege in my academic work to engage with individuals from all
walks of life and most places throughout the world. In my work at Stanford Medicine,
we now have activities and initiatives in our neighborhood and across the globe.
Several of the stories of these partnerships are told in this book. Other partnership
narratives shared here are those of my friends, and of the friends of my friends.
Partnerships for Mental Health: Narratives of Community and Academic
Collaboration is a text that follows from an earlier work that Christiane Brems,
Ph.D., Mark Johnson, Ph.D., and I created with many remarkable colleagues. That
book, Community-Based Participatory Research for Improved Mental Healthcare:
A Manual for Clinicians and Researchers, was published in 2013 (also by Springer
Science+Business Media). The manual laid the foundation for this collection, which
has a greater focus on partnerships as experienced by those who create them.
This next book richly tells the stories of collaboration. The narrative voice of
each chapter derives from the people who tell their story. Authors of this book are
immigrants, survivors of torture, mental health experts, urban people, rural people,
teachers, doctors, attorneys, students, and international leaders. Their stories matter.
These authors provide emotionally powerful tales that will, I believe, move, affect,
Preface xiii

and encourage those who encounter them in this book. Stories are influential. This
collection of narratives is inspired by these individuals, who believe that collaboration
can bring authentic mutualism, promise-keeping, and innovation to address the
hardest problems we face as a world community.

Stanford, CA, USA Laura Weiss Roberts, M.D., M.A.

Acknowledgements

The editors wish to thank their many colleagues who generously shared their expe-
riences and insights for the book.

We express our appreciation to Melina Salvador, who helped in the early devel-
opmental stages of this project, and to Madeline McDonald Lane-McKinley,
Ph.D.(cand.), Jennifer Pearlstein, and Megan Cid for their assistance at various
stages in the preparation of the book.

The editors and authors wish to express their utmost gratitude to Ann Tennier for
her dedication, hard work, and attention to detail on this book project. Her contribu-
tion was appreciated throughout the development of the project and can be seen
throughout the finished product.

The editors and authors also wish to thank Diane Lamsback and Richard Lansing
of Springer Science+Business Media, LLC.

xv
Contents

Foreword ......................................................................................................... vii

Preface ............................................................................................................. xi
Acknowledgements ........................................................................................ xv
About the Editors ........................................................................................... xxv
Introduction .................................................................................................... xxvii
Narrative 1 The Stanford–Santa Clara County
Methamphetamine Task Force ..................................................................... 1
Lawrence McGlynn
Narrative 2 Building Relationships with At-Risk
Populations: A Community Engagement Approach
for Longitudinal Research............................................................................. 19
Helen W. Wilson, Gloria J. Coleman, Brenikki R. Floyd,
and Geri R. Donenberg
Narrative 3 The Center for Youth Wellness:
A Community-Based Approach to Holistic
Health Care in San Francisco ....................................................................... 37
Suzanne E. Walker and Victor G. Carrion
Narrative 4 The Cambodian Lotus Thrives Under
a California Sun: How a Mental Health Clinic
Partnered with a Khmer Buddhist Temple to Reach
Killing Fields Refugees Living in California ............................................... 53
Daryn Reicherter, Sophany Bay, Bophal Phen, Tith Chan,
and Yeon Soo Lee

xvii
xviii Contents

Narrative 5 Kombis, Brothels, and Violence Against Women:

Building Global Health Partnerships to Address
Women’s Health and Empowerment ........................................................... 69
Christina Tara Khan
Narrative 6 Creating a National Native Telebehavioral
Health Network: The IHS Telebehavioral Health
Center of Excellence....................................................................................... 77
Steven Adelsheim, Caroline Bonham, Chris Fore, Joe Glass,
Dorlynn Simmons, and Leonard Thomas
Narrative 7 The Program of Assertive Community
Treatment and the University of Wisconsin
Psychiatry Residency ..................................................................................... 89
John Battaglia, Art Walaszek, and Claudia L. Reardon
Narrative 8 Laughing at the Rain.............................................................. 101
Daryn Reicherter
Narrative 9 From the Ivory Tower to the Real World:
Translating an Evidence-Based Intervention
for Latino Dementia Family Caregivers
into a Community Setting ............................................................................. 105
Dolores Gallagher-Thompson, Paula Alvarez,
Veronica Cardenas, Marian Tzuang, Roberto E. Velasquez,
Kurt Buske, and Lorie Van Tilburg
Narrative 10 Implementing a Peer Support Program
for Veterans: Seeking New Models for the Provision
of Community-Based Outpatient Services for Posttraumatic
Stress Disorder and Substance Use Disorders ............................................. 125
Shaili Jain, Kaela Joseph, Hannah Holt, Craig S. Rosen,
and Steven E. Lindley
Narrative 11 A Journey of Mutual Growth: Mental
Health Awareness in the Muslim Community ............................................. 137
Rania Awaad
Narrative 12 The Intercultural Psychiatric Program
at Oregon Health and Science University .................................................... 147
James K. Boehnlein, J. David Kinzie, Paul K. Leung,
Margaret Cary, Keith Cheng, and Behjat Sedighi
Narrative 13 Shared Learning in Community-Academic
Partnerships: Addressing the Needs of Schools .......................................... 163
Shashank V. Joshi, Roya Ijadi-Maghsoodi, Sarah Estes Merrell,
Paul Dunlap, Samantha N. Hartley, and Sheryl Kataoka