1. Briefly describe the burning issue, need, or question that you have addressed through your Fellowship.
At the heart of the fellowship experience is the advancement of a Vision for Change to address an important program, system, or policy issues in one’s professional context. The Vision for Change that I addressed during my fellowship was to use collaborative processes between multilevel organizations to influence policy, research, and clinical practice, to improve access to mental health care for children and families affected by intimate partner violence (IPV). Prior to the ZERO TO THREE Fellowship, I had just embarked on a research fellowship and was imagining how to meld my diverse interests in research, clinical work, and policy.
The World Health Organization calls IPV a global public health problem of epidemic proportions, yet despite the known sequelae of IPV, mental health and IPV services have unique socio–political histories and tend to function as distinct systems of service delivery, affecting children who are often caught in the cross hairs. While 85% of IPV survivors who present to advocacy organizations in the United States report at least one mental health problem, only one-third have seen a mental health professional during the past year. This mismatch in supply and demand points to the significant structural and systemic barriers that prevents survivors from accessing mental health care. Importantly, these obstacles are especially pronounced for minority women and for young children who suffer from compromised caregiving. Appropriate provisions of services for these survivors would ideally incorporate knowledge of both mental health and IPV-related concerns; yet, my research was the first to indicate that few models of such psychiatric service provisions exist.
In New York City, some of us began addressing this issue in 2014, initiating a tripartite partnership with private, public, and academic collaborators that imbeds skilled mental health clinicians within the Family Justice Centers (FJC), a network of resource centers for survivors of IPV and sex trafficking. Since 2017, this new collaboration has been funded by ThriveNYC and provides free, evidence-based treatment, including psychotherapy, skills-based learning, and psychopharmacology in a trauma- and culturally-informed capacity by the country’s largest public hospital system, NYC Health + Hospitals. By bringing experienced mental health clinicians to the community, the program is meeting the survivors where they are and where they feel safest. In a citywide program evaluation I led, our data demonstrated that not only do the survivors continue to report feeling safe physically, but they also report feeling safe emotionally with profound improvements in parenting.
Through the intense and thoughtful retreats, coaching, and supervision, the ZERO TO THREE Fellowship provided me with the skills to better articulate the needs, share and highlight the Vision, and steer me in my current path. I’m happy to say that through the Fellowship, I accepted and started my new position as the inaugural Medical Director of New York City’s Health + Hospitals Family Justice Center Mental Health Collaboration. This is the nation’s first such integrated mental health model and New York City now boasts the largest network of FJCs in the country. The Vision is coming to fruition and others are taking notice.
2. What has been the most beneficial part of being a ZERO TO THREE Fellow?
At the time I applied to be a ZERO TO THREE Fellow in 2017, I was embarking on a two-year research fellowship after completing six years of training post medical school. So, when the ZERO TO THREE fellowship was presented to me, the idea of another two-year fellowship seemed quite daunting. But my mentor, Dr. Catherine Monk, recommended that I apply. In my application, I stated that one of my goals was to gain additional perspective on leadership and career paths. ZERO TO THREE had the triple threat of combining research, policy, and clinical care towards advancing the lives of young children and families. These were the same goals that I envisioned for myself. However, little did I know that by being a ZERO TO THREE Fellow, my world would be opened to the immense opportunities for collaboration and care and with it, tremendous personal growth. I have to thank my excellent co-fellows for their humility and brilliance in showing me the depth and breadth of early childhood mental health. These are some lasting friendships that will surely stand the tests of time and distance. Lynette Aytch, the Fellowship Coordinator, was also crucial in shaping the curriculum that allowed for such deep soul searching and personal exploration. I learned so much about the field, myself, and what it means to be a leader. Most importantly, to also “lead from where you are.”
3. How have the current events, crises, and societal upheavals impacted your work and/or your perspective of the work ahead of you?
Prior to COVID-19, significant structural and systemic barriers prevented IPV survivors from accessing high-quality mental health care for families and young children. Importantly, these obstacles were especially pronounced for Black and Hispanic women, who in the United States are less likely than White women to seek help from various formal and informal sources. During COVID-19, the continuing challenge is to create and maintain a system that can meet the ever-growing mental health needs of IPV survivors and families. From a systems perspective, we have introduced telehealth, while understanding the benefits and the limitations. Technology has allowed for greater cross-collaboration across institutions and immediate access to clients, yet privacy, confidentiality, and assessing safety present ongoing challenges that require creative solutions. From a workforce perspective, the same benefits and challenges exist coupled with the marrying of multiple roles. Yet, these issues were present prior to COVID-19 and in the words of Lynette Aytch: “Don’t waste a crisis.” The time is now to feel emboldened to make lasting change and take accountability and action towards dismantling systemic racism and systems that unfortunately put people in harm’s way. Starting a new job during a pandemic is never easy as one misses the nuanced indirect learning of culture when working remotely, but I am fortunate to have a job that allows me to think about these disparities and to strategically improve access to mental health care for young children and families.