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