Screening for the Unknowns

The “Medical Family Therapy: Cross Cultural Implications” course that I taught in Swaziland on the campus of African Christian College in August and September had a number of modules. Some modules were just read, think, and apply.  Other modules were heavy on application. One of those modules was on the use of screening inventories in behavioral health settings.

Screening inventories are used to rule out things that are not there and to rule-in things that are there and demand clinical attention. They are most frequently brief inventories. Preferably, they are less than ten or so items.  The inventories we learned were the ACE(Adverse Childhood Experiences), the PHQ-2 and PHQ-9 (measuring depression), the GAD-7 (measuring anxiety), the ORS/SRS system of Dr. Scott Miller which measures the challenges of the person since the last session as well as the evaluation of the session that is just ending. We gave some attention to the Marital Attitudes Scale and a recent publication by Hinson, Hargrave, Northrup, and Robertson (2017) though it is longer, i.e., 48 items that assesses the client’s commitment to the marital relationship.

The learning process included reviewing the literature, hearing me lecture on each screening inventory, and then completing, scoring, and interpreting the results on oneself. We then role-played giving each inventory to a client. This was no small task as the students were learning the inventories for the first time as well as processing one’s own unresolved issues. Obviously, we spent much time discussing the scores, their ratings as low, moderate, and high, and how to address personal concerns.

In view of our stated theological orientation of bring shalom into a broken world, these inventories and the students’ abilities to use them and use them well can help to create shalom for people who are broken or broken hearted. The inventories do not address how well one is, but rather how wounded one is.  On the one hand, the absence of a high score, or the presence of a low score suggests that one is doing well in terms of that which the inventory measures, but in integrated healthcare settings, people are generally going to be more troubled than less troubled.

If a therapist knows what the problems are, then a collaborative relationship can be created so as to address the issues. A caring, compassionate, and fully informed clinician can ease a client’s anxieties about discussing matters that are personal. A person who is trained in how illnesses can impact the family can be useful on the “front-line,” so to speak of the health and well-being of clients.

 

 

The students seemed to gravitate to Dr. Scott Miller’s ORS/SRS system. Here is the link for more information on this topic: https://www.centerforclinicalexcellence.com/. Dr. Miller gave the students permission to download and use his materials and the students were thankful for the access to these materials. The Outcomes Rating Scale is simply a four-item, ten-point Likert scale, inventory that the client fills out immediately prior to the consultation.  This inventory assesses the challenges of the person’s life and it orients the therapist toward what needs to be worked on.  At the end of the consultation, the Session Rating Scale is completed.  Again, it is a four-item, ten-point Likert scale inventory that assesses the quality of the therapy session that is just ending. This is immediate feedback from the client to the therapist and helps to keep the process positive and constructive.

The ACE, or Adverse Childhood Experiences, inventory could be pivotal for their settings and homelands.  There is must loss, conflict, and trauma that defines the worlds from which students come.  They are familiar with suffering and grief.  They learned that the more trauma a person experiences in his or her life prior to the age of 18, the greater the probability of experiencing various medical conditions.  Addressing just the medical conditions is inadequate.  It is imperative that clinicians address the underlying trauma that prompted the rise in the number and severity of the medical conditions.

These students love their homelands, their church, and the Lord. They are convicted about serving God these unique ways when they return home. These tools are a hands-on way of serving the needs of people by assessing their lived experiences.  When they do so, they are bringing about shalom in their broken worlds.  How our world needs shalom.  Shalom in Africa and shalom in America. That is exactly what we all need.

 

 

Coming and Going and Being Sent: Thuma mina (Send me)

In the early morning hours, these words from a psalmist of old are striking, “I know that the Lord secures justice for the poor and upholds the cause of the needy. Surely the righteous will praise your name and the upright will live before you.” Those are the last two verses of psalm 140, penned by David. I find them striking.

An application of that text also resonates deeply. For those two weeks that we were in the presence of ten African students from six African countries deeply penetrated my soul. The course was an upper division elective.  They were either third year counselling and psychology students, or they were second year students. The syllabus was daunting. They would have to read a lot, ponder a lot, learn a lot, and apply a lot. 

Here is what the syllabus said:  This elective in the psychology and counselling track is designed to orient students in the discipline of medical family therapy and its potential applications in their countries of origin. Consideration will be given to the cultural context from which she and he comes. Theory and practice of working collaborative healthcare settings with individuals, couples, and families in which illnesses are assessed and treated.

Here were the course objectives: 
 

1.         Students will learn and articulate the biopsychosocial/spiritual model
2.         Students will learn principles and practices of medical family therapy as a
            discipline with application to her or his country of origin
3.         Students will acquire basic information relative to illness and family
4.         Students will practice engagement with medical personnel in primary care clinics
5.         Students will develop a preliminary model for working in the country of origin
6.         Students will maintain an annotated bibliography for daily readings that include
            engagement questions and applications
7.         Students will learn the art of constructing both a genogram and an ecomap

The human part is that these ten students were prepared for this course. They could write well and speak English well. They had a clear vision for returning to Malawi or Zimbabwe or Tanzania or South Africa or Swaziland or Zambia and serve God and the people of their homeland.

They know intimately the impact of trauma on their lives and the lives of their families. They know well the impact of HIV/AIDS, or TB, or cancer, or any number of other health conditions.

They had just never put all of these things together, things such as “how does a trained therapist conceptualize and engage a person and a family in which illness is pervasive,” or “how does one work to alleviate pain and suffering in the marginalized who have socially unacceptable illnesses,” or “how can serving those with health problems be service to God,” or “how does illness or disease come to be the central organizing principle in families,” or “if we could develop one, what would an internship or a clinic look like that had both behavioral health and a focus on illness of its patients,” or “how could a ministry in the church create a focus on behavioral health and medical needs of the people in its community.”

By reflecting on those questions, learning theory and practice of medical family therapy, role-playing curb-side consults or “friendly handoffs,” and a myriad of other things that occur in collaborative care clinics, they caught the vision for what could happen in their homelands. It was riveting to see how they grasped the ideas and practiced, and how they reflected upon applications in her or his country of origin.

On Monday of this week an internship that captures these principles and practices started at a clinic not far from the campus. Dr. Bob Whitaker, long-time medical missionary in Nigeria and now medical missionary in Swaziland, had agreed to work with Lynn Rhodes and one of my students to develop an integrated care focus. May God's grace shine upon that effort.

Justice and righteousness have a lot to do with the motivation to learn and apply those things.  A theology of shalom, justice, and righteousness undergirded the class. Shalom had been broken in the garden. The breakup in families and the breakdown in health of family members and community members were signs of that violation of shalom. Bringing ones’ self into the mix of pain and suffering, just as Jesus emptied himself as He entered our world, is a meaningful attempt to re-create shalom insofar as we can re-create it in this broken world, and as we point to the ultimate healing when the Lord comes again to claim His own.

Yes, I believe God cares for the mistreated and those for whom justice has not come. I believe my job and the jobs of my students is to bring about justice and righteousness insofar as we are able. We validate stories and we convince people that they are worthy as we engage, listen, and validate.

That can happen in communities from which my students come in Africa.

 

 

 

Voices I Have Heard

Voices I Have Heard

Waymon Hinson

August 31, 2017

*“Get out of bed
This is no time to sleep.
You must get prepared
Your promises to keep.”

**“Just a few more minutes

If you don’t mind
I’m pretty well prepared
For class this time.”

***We have come from afar

And we love what we do
To share our ideas
And to apply them through you.

Two weeks are too short

You’ve captured our hearts
Prayers for all that you’ll do
Long after we depart.

The Lord has called you

From yourselves he has saved you
Enter the broken spaces
There will be many such spaces.

Family therapy in clinics

People are broken and sad
Your sacrifices and preparation
Will make those hearts glad.

From Malawi Tanzania and Zambia

You have come to learn
To Zimbabwe South Africa and Swaziland
Someday you will return.

Your country of origin

You know quite well
HIV-AIDS diabetes PTSD depression
And all such manner of hell.

Charity Edith Tadala Admire Julia

Bring about shalom
Tendekai Prudence Clide Veronica Ncobile
And help them find their way home.

We are not called

To fix everything we see
Just a cup of cold water
With Baba we are free.

*“Dr. Hinson tell us more.”

Your faces implore.
**“Just take what you know
Into a good therapist you’ll grow.”

***We’ll soon say goodbye

Until in the forever we meet
Do well with your callings
There familiar faces we’ll greet.
______________________
*Students’ imagined voice
**Professor’s imaged voice
***Professor’s ponderings

Swaziland and ACC: Things We Experienced, Things We Learned

Two weeks ago today Charla and I were into the second week of teaching "Medical Family Therapy: Cross Cultural Applications" to ten students at African Christian College. She had already met with three groups of women and had given out the sets of hygiene kits made by her and her friends from the Park Avenue Church of Christ here in Denison. Today we are continuing the daily and even hourly reflections about the trip. Here are a few of them.

#1: Thanks to many, we were graced with $5,435 in contributions. We are very thankful.

#2: With those contributions we were able to get there and back, give textbooks to students and the library, and prepare the hygiene kits. Those who received the kits and those students who received the books were unanimously grateful. On the first day of class when we were discussing the syllabus and the required readings, they were surprised that the primary textbook was for them to read and even to write in.

#3: Ten students attended the class from six African countries: Malawi, Tanzania, Zambia, Zimbabwe, South Africa, and Swaziland.

#4: Forty-six hygiene kits and sets of underwear were given out.

#5: The students were prepared, well read, skilled at writing and expressing their thoughts and opinions, and participated well in classroom discussions and role-plays. Each student was required to report upon her or his country of origin and the status of medical care and behavioral healthcare, all of whom said each was non-existent. Each was required to articulate an uninformed opinion as to how he or she could integrate the two in that country. This was before the class even started.  Then, at the end of two week class, each again spoke as to how the integration of medical and behavioral health could be integrated. The papers were amazing to say the least. Not only had they more than adequately captured the principles and practices of medical family therapy, but their vision for returning to their homelands and working was inspiring.

#6: The ten students come from different countries and different living situations. Some are from "way down in the village" and others are from larger and more modern towns. Each student expressed a clear vision for taking an integrated approach back home and were even developing strategies to do so.

#7: These students love God and are called into the service of the King of Kings and long to serve God back home.  They have one more semester of academics and internship and then they will go home. Their commitment to their countries, families, and church was inspiring.

#8: Worshipping with them in chapel every day was inspiring. Eating with them in the dining hall and sharing their traditional foods was enriching and enlightening.

#9: Hearing them express their gratitude for us coming and teaching was inspiring.  Their words of "I never knew that before," "I never have heard of these things," or "I believe I can do this back home" were deeply encouraging and meaningful. Several of them talked about the seeds we had planted and how in the generations ahead, those seeds will develop and grow. Already, at least one student is encouraging ACC to have this specific course taught every other year.

#10: It was a humbling experience to work in the English language with these students while knowing that their languages were unique and beyond our comprehension, that their cultural contexts were things that we could not understand, and that they understood well from whence they had come and to what they were returning. Charla and I worked hard to hear them well and to understand them, and to a one they seemed grateful that we cared enough to work that hard.

#11: Even as we speak, there are conversations taking place as to how to create an internship site within which at least one student can continue to learn the art and science of providing integrated health care in a medical clinic. One particular physician, Dr. Bob Whitaker, whose clinic is in Manzini, interviewed with us in class and has expressed an interest in this as has the lead faculty member at ACC in the counseling department. He is Lynn Rhodes. I was encouraged by our conversations.

Since this report could go on quite longer, let me summarize by saying that those three weeks in Swaziland and on the ACC campus with its students, faculty, and staff provided experiences beyond our imagination. When asked what it was like, the only thing I could say was, "It was amazing. It was life-changing. Thank you for asking."

Ode to Stem Cells

Today was a pivotal day for the three of us partners who are working to develop various services within the field of regenerative medicine. We are not physicians. We are behavioral health specialists with strong opinions about what individuals and families need. A strong ethic is required in this area of bioethics. Look for a summary of our manuscript on these pages when it is nearing completion.  I was drawn to this effort out of a sense of justice.  On more than one occasion I have said, "Unless things change, only rich white people will be able to write a check for these treatments," and one response is "anyone who is rich."  That person is correct. My desire is for all of God's children to have stem cell treatment options. From what I have read thus far, there is a low percentage of persons of color in clinical trials and databases around the world.

Here is a poem that I originally posted here back in March.  Once more, please check out these sentiments. As always, please feel free to leave your comments below..

Ode to Stem Cells

 

Pain is what I feel

From my head down to my toes
Everywhere I move
And nobody really knows.

This back is old

Some days are worse than others
I feel it sometimes really bad
Sometimes I feel the shudders.

This pain down in my knees

I know I’m growing old
It’s worse some days than others
Especially when I’m cold.

Sometimes I can’t even feel

My toes nor even my fingers
So, I just sit and wait and wait
And the days turn into lingers.

The medicine I take

Only relieves me some
For a better day I’m longing
Before my time on earth is done.

Those pains no one really gets

No one can really see
The hurt my body feels
From my shoulders to my knee.

Sometimes I cannot breathe

Much more than just a gasp
These lungs are wearing out
Some day will be my last.

These eyes they cannot see

I used to could find my way
Now I fumble all about
Hardly sensing the light of day.

I hear there a new science

Going on in labs around the globe
If I only had the money
Perhaps I’d have more hope.

People like me want to see

People like me want to breathe
People like me have some hope
From our heads down to our knees.

They have many fancy names

Pluripotent mysenchymal stem cells
Snagged by patented devices
From my human body where they all dwell.

Gives people a lot of hope

Do you know some of them
Let’s pass the word and pray the prayers
And look for that little stem.

God’s grace is found

Upon all of us in sight
Let’s keep on doing good medicine
You know it’s really right.

Let’s make sure all of these treatments

Can make for a better story
For black and brown rich and poor
For God to receive the glory.