From learning sign language to counseling refugees to spending two weeks conducting mental health screenings on an American Indian reservation, psychology interns at the University of Colorado Health Sciences Center (UCHSC) are gaining experiences in cultural diversity while training to provide health service psychology in underserved communities.

In September, during their first week on internship, six interns received training in sign language to garner basic communication skills to interact with deaf and hard-of-hearing co-workers or clients. Two weeks later, the interns left for a one-week trip to an American Indian reservation in South Dakota to conduct mental health screening of children at Pine Ridge School; they plan to return in March to follow up on students' school adjustment and any other mental health issues identified.

UCHSC can continue to offer such diverse training experiences to underserved populations this year thanks in part to a $158,000 boost for each of the next three years from the U.S. Bureau of Health Professions-funded Graduate Psychology Education (GPE) program, which has awarded grants since 2002 to psychology training programs that work with underserved populations. The University of Colorado was one of 20 programs selected in the latest batch of GPE winners (see sidebar)--four of which are first-time GPE winners. UCHSC is one of the 16 repeat GPE recipients.

With its renewed funding, UCHSC expanded the number of interns it trains from five to seven, added to the time interns spend on the American Indian reservation, added an internship rotation for one intern to work with deaf and hard-of-hearing clients, established new training experiences in health psychology and taught all interns sign language with follow-up classes throughout the year. Interns choose one major rotation track during their internship but may be exposed to other tracks through seminars, including developmental disabilities, deaf and hard-of-hearing clients, American Indian clients, corrections, maltreated children and youth, or underserved populations in primary-care settings.

"All of our interns are going to have exciting new training in health services psychology with underserved groups," says Hal Lewis, PhD, the UCHSC director of psychology training. "In addition, they will have an enriching experience gaining cultural competence, cultural sensitivity and an appreciation for cultural diversity in their work. GPE has allowed us to introduce really exciting elements into our program."

Working with deaf and hard-of-hearing clients

One such UCHSC opportunity is the GPE-funded Deaf Link internship track, which this fall will enable an intern to do psychotherapy and conduct psychological evaluations of children and adults who are deaf or hard-of-hearing, including those awaiting cochlear implants.

Therapists who work with clients who are deaf or hard-of-hearing must be knowledgeable about the culture and language if they are to provide appropriate services, says Robert Baldwin, who founded UCHSC's Deaf Link and heads up the internship track.

That's why fourth-year doctoral student Brian Hartman of Argosy University/Chicago Northwest, who began his internship this fall, was a perfect match. Since Hartman is deaf himself and fluent in sign language, Hartman believes he can better help clients who are deaf or hard-of-hearing by communicating with them directly using sign language instead of through an interpreter. For example, he notes, an interpreter may increase the likelihood of words getting lost in translation, and clients may have concerns about confidentiality issues arising by having a third-party in the room.

The Deaf Link track also gives Hartman the opportunity to work directly with deaf and hard-of-hearing children, a population he especially wanted to target because of the importance of early identification of mental health issues.

What's more, Baldwin says he hopes the internship will increase the number of mental health professionals trained to work with deaf and hard-of-hearing clients. In fact, all UCHSC interns will attend seminars that highlight competency issues in working with clients with disabilities, including using sign language or interpreters with clients who are deaf or hard-of-hearing.

Learning Native American culture

Adding to that diverse training ground, all UCHSC interns spend time on the Pine Ridge Indian Reservation in South Dakota, where they conduct mental health screening--such as for adjustment issues--of 80 to 100 Native American children at Pine Ridge School.

Before leaving for the reservation, interns attend a UCHSC seminar focused on the Lakota Indian culture and provided by Candace Fleming, PhD, a member of the Kickapoo, Cherokee and Oneida tribes, and the primary UCHSC psychology faculty member for the American Indian internship track. UCHSC has been sending interns to the site for more than 10 years, but the GPE money will now fund a second trip in the spring to monitor students' progress.

Interns also meet with tribal elders, child protective services workers, health personnel at the local Bureau of Indian Affairs health center and school staff to assess students' needs and learn about the interplay of physical, mental and spiritual health in the Native American culture. During the second trip, interns and supervising faculty provide consultation to the mental health personnel at Pine Ridge who work with children and adults affected psychologically by poverty, unemployment, alcoholism, high mortality rate, death and grief, domestic violence and sexual abuse.

"Trainees see how physical health, spiritual health and mental health are interconnected and supported within Native American traditions, despite the presence of substantial stressors," Lewis says.

Screening refugees

For some interns, that cultural diversity training also extends to working with refugees from such war-torn places as Iraq, Bosnia, Afghanistan and many African countries. During a primary-care rotation, they conduct mental health evaluations of refugees who have just arrived in the United States, says Deborah Seymour, PsyD, director of behavioral science in UCHSC's family medicine department.

The United States receives about 75,000 refugees each year--1,200 of whom come to Colorado, which following a federal mandate must conduct health and mental health screening of any refugee who enters the United States, Seymour notes.

"Some are very traumatized," Seymour says. "They've been exposed to war, torture and other trauma, like rape. We work with them to prevent retraumatization and are right on the front lines."

However, interns face challenges since only about 1 percent of the refugees they work with speak English. That means interns usually must tap interpreters to provide services, which, like working with interpreters for deaf and hard-of-hearing clients, may raise ethical issues of having a third-party in the room.

For that reason, Marina Papirova, PhD, who completed her internship at UCHSC and doctoral program at the University of Denver in August, was initially hesitant to enlist interpreters, but ultimately found them crucial to breaking down language barriers.

Herself a refugee from Ukraine, Papirova selected this rotation because she was fascinated with helping the refugees adjust to a new culture, as she once did.

"I wanted to give my input, knowledge and experiences as a refugee," she says. Papirova's own experience is a case in point: She arrived in the United States 13 years ago not knowing English; today, fluent in English, she plans to develop a niche practice that targets counseling Russian-speaking as well as other refugees living in Colorado.

UCHSC uses its GPE funding with the hope that its interns will take on such careers that reach diverse and underserved clients, Lewis says. He hopes their experiences working with a wide range of underserved clients, which the GPE funds have made possible, will spark greater cultural sensitivity and competencies in interns' future work.