Post 4: Midpoint of My Internship

In my previous three blog posts, I have stated how Community Psychiatry PRIDE, my internship organization, addresses social justice. I have spent plenty of time elaborating on the social problem we are targeting, the significance of our work, and the difference we aim to make.

At the midpoint of my internship, I feel I should also talk about the arduous work behind the higher purpose. It is exciting how we are trying to bring treatment to the most-needed communities or to help high-risk young men break the cycle of incarceration and poverty, but the hard work building up to the glamour of social justice practice should also be noted. While I am working on a project about implementing evidence-based treatment to resource-limited communities, it includes endless data entry and going back and forth to check data. No matter how excited you feel about the high order purpose, you will need to deal with the arduous part of the job. It is important to be aware of this, and find a way to stay motivated.

There are some incidents I want to share that keep my morale up. The first time I tried to take the commuter rail from Chelsea to North Station after work, I took the wrong one and I ended up in Lynn. I was worried and anxious, looking into the map at the Lynn station that did not make any sense to me. A middle-age man approached to me and asked me whether I took the wrong train too. He started talking to me and told me that the next train back to Chelsea was in twenty minutes. He was super talkative and based on what he told me, it was not hard to notice that he was struggling as he constantly switched from job to job, frequently visited emergency rooms, and was chronically involved with psychiatrists. I was suspicious when he first approached me, and I felt embarrassed for thinking this way as I found him to be a genuinely good person. He talked about his favorite novel and showed me how he learned math by himself on the back of the train ticket.

The idea of Community Psychiatry PRIDE to bring culture-sensitive treatments to resource-limited communities is based on getting to know people’s lives and the struggles in the communities. That incident in Lynn was my first time to be with one of the people I want to help through this internship, and I was moved by his faith in life, curiosity about the world, and eagerness to learn. This experience helps me to stay motivated through this arduous work, because they are not just quantitative and qualitative data anymore, but real people who are holding on to faith in life and seeking help.  

-Bingyu Xu ’19

Post 3: Progress on Social Justice

The goal of Community Psychiatry PRIDE is to increase the access to and quality of mental health care in community-based agencies across Massachusetts. In many poor communities, such as Chelsea where Community Psychiatry PRIDE is based, people are stuck with crime, violence, and poverty, and thus are more vulnerable to mental health disorders such as depression, anxiety and post-traumatic stress disorder. Adequate and effective health care is often not provided to these communities in need. Community Psychiatry PRIDE conducts research exploring the disproportionate mental health burden in under-served and resource-constructed communities. Through one project specifically–leveraging routine clinical materials and mobile technology to assess CBT quality–Community Psychiatry PRIDE aims to relieve this mental health burden by developing an instrument to evaluate and improve the quality of evidence-based treatments of multiple mental disorders.

Cognitive behavioral therapies (CBT) have been proven to be effective for a wide variety of psychiatric diagnoses, and have been used as a first-line treatment for a variety of mood and anxiety disorders. Thus, effective delivery of CBT can greatly relieve the mental health burden in resource-limited communities. However, there is insufficient emphasis on quality assurance for CBT. Decreases in CBT quality can significantly reduce the intended symptom improvement. It is important to monitor treatment quality and make sure the treatment is delivered as intended. Some research suggests that many providers do not implement CBT with fidelity. In fact, assessing fidelity on large scale has been a major challenge in implementation science.

Existing ways to test fidelity–rating recordings of therapy sessions–are time-consuming and labor-intensive, thus even less practical in resource-constricted communities. This project aims to score fidelity using CBT worksheets to test fidelity in a short and effective manner. On the whole project level, the additional use of routine clinical materials, which poses little additional burden to providers, can make large-scale quality monitoring feasible in resource-limited communities, thus enhancing the ongoing continuous quality improvement in clinics and leading to improved symptom outcomes.

For me, as a research assistant, it is motivating and exciting to think about why my work matters and how my small efforts can make a contribution to the whole process. I am currently working on data storing and tracking, which are tiny steps of the early stage of this project. However, properly conducting these small steps ensures the validity of the data used in later stages of the project and the smooth process of the project. The goals always sound promising and encouraging, but there are countless small steps building up to the final goal. There will also be countless research assistants, like me, devoting their efforts to these countless small steps. I feel grateful to be a small part of the whole process, and feel motivated to make my tiny contribution to the success of the project.

-Bingyu Xu ’19

Post 2: Four Weeks at Community Psychiatry PRIDE

During my three years as a member of the Brandeis community, I have been deeply absorbed in and profoundly impacted by the Brandeis culture that values diversity, equity, and inclusion. Brandeis considers social justice as one of its central missions, aims to involve students in this just and inclusive campus culture, and encourages students to become active citizens in this multicultural world. I am grateful that I can experience such campus culture while going through the stage of my life where I am establishing values and building self-identity.

Through social norms and expectations, we grow up to know about social identity categories such as socioeconomic status, race, gender, and sexual orientation. Such learned social identity categories can be the roots of discrimination and bias, as people are often defined and confined by these categories. One morning during this summer when I took the commuter rail from Waltham to Chelsea for work, I noticed the diversity in the carriage of people from different cultures with different jobs. I was struck by the fact that I never felt labeled based on my race, gender, age, or any other social identity categories. In that carriage, I did not feel like I was labeled as an Asian or a girl; I was just a person who was ready to start another day of life like everyone else in that carriage. After all, we are all the same after stripping off the identities society imposes on us. Regardless of race, gender, socioeconomic status, and other social identity categories, we should all be given the same opportunity to pursue our dreams. The world we are now living in is far from perfect. In fact, it is unfortunately full of inequity, bias, and discrimination. When I think back, I feel extremely grateful that the Brandeis campus culture and the people I am close to have given me the reassurance to disregard the identity categories the world tries to impose on me and the confidence to stand as equal to pursue my dreams.

Lee Anne Bell (2013) defines social justice in Readings for Diversity and Social Justice as “full and equal participation of all groups in a society that is mutually shaped to meet their needs.” While I am lucky enough to have such a supportive environment and the resources, such as a college education, to reach towards my dreams, many people are not given the same opportunities to meet their needs. There are many poor communities suffering from the reverberations of perpetual imprisonment, sustained violence, and family instability. Each year, tens of thousands of inmates are either released from Massachusetts correctional facilities or are serving probation sentences. The high risk 17-24 year old young men are the target population of Community Psychiatry PRIDE’s interventional model. Because of the way resources are allocated in our society, these young men in poor communities are disadvantaged in terms of education, more vulnerable to mental health problems, and more prone to crimes. The problem progresses as there is lack of the resources necessary to keep themselves from re-offending and returning to jail. More efficient programs are needed to give them the chance to change behavior, keep a job, and break the cycle of incarceration and poverty.

Community Psychiatry PRIDE’s local community partner organization aims to build transformational relationships with high-risk young men through outreach to those who suffer from reverberations of crime and poverty. Community Psychiatry PRIDE hopes that by engaging these young men in stage-based programming, they can provide resources necessary for these high-risk young men to break the cycle of incarceration and poverty. Community Psychiatry PRIDE’s role in this program is to develop an evidence-based treatment of cognitive behavioral therapy tailored to the community’s specific struggles. We hope this program can help high-risk young men to move out of violence and into jobs.

-Bingyu Xu ’19

Post 1: My first week at Community Psychiatry PRIDE

PsychiatryPRIDE logo

Hi! My name is Bingyu Xu and I am a rising senior at Brandeis double majoring in Psychology and Economics. This summer, I am completing an internship at Community Psychiatry PRIDE as a research assistant. Based out of Massachusetts General Hospital under the Division of Public and Community Psychiatry, Community Psychiatry Program for Research in Implementation and Dissemination of Evidence-based Treatments (PRIDE) aims to reduce the disproportionate mental health burden in resource-constricted communities. Community Psychiatry PRIDE has built strong partnership with community-based providers across Massachusetts to close up the gap between science and practice in the field of clinical psychology. Research projects of Community Psychiatry PRIDE focus on effective delivery of evidence-based treatment for mental health disorder that are culturally relevant and responsive to the unique challenges of the community.

One of the projects that I mainly work on is Implementing evidence-based life skills programming for reducing recidivism among high-risk youth. My tasks include data collection, entry, and tracking, and formatting codebook. Together with a local community organization, Community Psychiatry PRIDE works to disrupt the cycle of incarceration and poverty in urban communities across commonwealth. Because of the reverberations of perpetual imprisonment, sustained violence, and family instability, tens of thousands of inmates each year have difficulties keeping themselves away from re-offending and returning to jail. The 17- to 24-year young men that this project targets on are disconnected, under-educated, and unable to success in traditional programming. Therefore, Community Psychiatry PRIDE aims to develop evidence-based treatment of cognitive behavioral therapy that are good cultural fit for participants. Community Psychiatry PRIDE holds the belief that these incarcerated young people, when re-engaged through positive and intensive relationships, can change their behaviors and develop life, education, and employment skills to disrupt the cycles of poverty and incarceration.

Community Psychiatry PRIDE’s determination to improve the mental health in resource-limited community is what attracted me to this position in the first place. People who in live neighborhood full of crime and violence are more vulnerable to mental disorders. Their incarceration and disadvantages in term of education and socio-economic status exist not due to what kind of people they are, but because of the way our society is structured and the way the resources are allocated in our society. I share the belief with Community Psychiatry PRIDE that when provided with appropriate resources, these high-risk youth can break the vicious circle and thrive. Community Psychiatry PRIDE has been dedicating to understanding the challenges of implementation and dissemination these recourses, and developing culturally suitable treatments for these communities.

My goal for this summer is to become familiar with all kinds of psychiatry research laboratory activities. Since I plan to enter a doctoral program in clinical psychology, I consider this internship as opportunity to train myself as a future researcher.       

-Bingyu Xu ’19